Care Home: Appletree Care Home

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What the care home does well Staff have a good understanding of residents` needs and observations made indicated that staff respond appropriately. The staff listen to residents if the express any concerns and deal with these promptly. The residents are receiving their prescribed medication and all senior staff has received accredited training. There are no medication errors. Though the cooks are currently off work temporary arrangements are in place to ensure that residents receive a choice menu. Staff dealt with a complaint made about the food promptly and menus were put in place to the satisfaction of the person who made the complaint. The building was clean and tidy and there were no unpleasant odours. Records in the home indicate that the "handyman" deals with repairs quickly. Staff are doing NVQ training if they have not already done so and good training opportunities are available for staff. The residents stated that they like living in Appletree and spoke of this as being their home. The senior staff have worked hard in the absence of the manager to maintain standards in the home. What has improved since the last inspection? Since the last inspection a new extension has been created and this has ensured that residents who dementia type illnesses can be cared for in a dedicated part of the building. There is a structured activities programme in place. An improved newsletter has been developed that keeps residents up to date with what is happening in the home. Some bedrooms and lounge areas have been decorated to a good standard. Comments in the staff surveys identified a number of improvements in the home since the new manager took over. What the care home could do better: The written care plans that demonstrate how residents assessed needs are to be met must include more detailed information to show what actions staff carries out. The risk assessments documents must be updated, particularly for those residents who have behaviours that challenge and can result in aggression. The daily records should include more information as to how people spend their day. The bath sheets should be withdrawn from use and any records related to personal bathing should be incorporated into the care plans. Staff must follow the guidance of the Royal Pharmaceutical Society when ordering medicines from the GP. An experienced cook should be in post at all times and all cooks must undertake specialist training in health and nutrition. Bedroom doors must not be wedged open as this compromises fire safety within the home. The shower room in the dementia unit must have remedial works carried out in order that it can be used. Decoration must take place to those areas of the home as identified in the report. A full employment history must be obtained for all staff who are employed to work in the home. Records must be maintained that confirms that all staff take part in regular fire drills and receive regular fire instruction as set out in the guidance issued by the Fire Authority. All staff employed in the home must within 14 days take part in at least 1 period of fire drills and fire instruction.In the absence of the manager a designated person must be in place to deal with the day-to-day management of the service. This position must be supernumerary to the rotas. CARE HOMES FOR OLDER PEOPLE Appletree Care Home Frederick Street Meadowfield Durham DH7 8RT Lead Inspector Clifford Renwick Key Unannounced Inspection 30 July & 7 August 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 Appletree Care Home DS0000061010.V371659.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. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appletree Care Home Address Frederick Street Meadowfield Durham DH7 8RT 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) 0191 3783152 0191 3782825 appletree@carehome.wanadoo.co.uk Maria Mallaband Care Homes Ltd Manager post vacant Care Home 57 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (31), Physical disability (15) of places Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Dementia: Up to 26 persons with dementia (over the age of 60 years) may be accommodated, commensurate with the home`s Statement of Purpose. Physical Disability: Up to 15 persons with a physical disability (over the age of 55 years) may be accommodated, commensurate with the home`s Statement of Purpose. 31st July 2006 Date of last inspection Brief Description of the Service: Appletree Residential Care Home is currently registered to provide care for up to a maximum of 48 older people in three different registration categories of Older Persons, Physical Disability and Dementia. There are limitations as described above regarding the maximum numbers of residents who can live at the home in each category. The home is owned and managed by Maria Mallaband Care Homes Limited. Appletree Residential Care Home is located off the A690 Durham to Crook road in the village of Meadowfield some 3 miles from the centre of Durham City and is on a regular bus route. It is a large modern two-storey building with the benefit of two passenger lifts to the first-floor and the Acorn suite. All bedrooms are single accommodation with the benefit of en suite facilities. There are a number of different communal lounges and dining areas throughout the home. The home has a well-kept enclosed garden space for the use of residents and visitors. The weekly fees to stay at Appletree Residential Care Home are currently £419 to £445. Car parking spaces are located to the front of the home for the use of relatives and visitors. Appletree Care Home DS0000061010.V371659.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 that the people who use this service experience good quality outcomes. Before the visit: We looked at: • • • • • • Information we have received since the last visits in 31st July 2006. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The provider’s view of how well they care for people. The provider in the annual quality assurance assessment (AQAA) submitted information to confirm what they are doing in the service. We looked at information we received in surveys from staff and residents. The Visit: An unannounced visit was made on the 30th July 2008, and an announced visit was carried out on 7th August 2008. During the visit we: • • • • • • • • • • Talked with people who live in the home and also staff who were on duty. Held discussion with the senior care officer, administrator and regional manager. Observed staff working practices. Looked at information about the people who live in the home & how well their needs are met. Looked at other records, which must be kept in relation health and safety and staffing. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. Checked what improvements had been made since the last visit. Spoke with staff. We also gathered information from looking at care records to assess how staff supports the residents with their assessed needs. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 6 • We also focused upon looking at care files for 4 residents as a part of the inspection we refer to this as “case tracking”. And this involves looking at all records of the care for a named individual. We told the regional manager what we had found. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. What the service does well: What has improved since the last inspection? Since the last inspection a new extension has been created and this has ensured that residents who dementia type illnesses can be cared for in a dedicated part of the building. There is a structured activities programme in place. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 7 An improved newsletter has been developed that keeps residents up to date with what is happening in the home. Some bedrooms and lounge areas have been decorated to a good standard. Comments in the staff surveys identified a number of improvements in the home since the new manager took over. What they could do better: The written care plans that demonstrate how residents assessed needs are to be met must include more detailed information to show what actions staff carries out. The risk assessments documents must be updated, particularly for those residents who have behaviours that challenge and can result in aggression. The daily records should include more information as to how people spend their day. The bath sheets should be withdrawn from use and any records related to personal bathing should be incorporated into the care plans. Staff must follow the guidance of the Royal Pharmaceutical Society when ordering medicines from the GP. An experienced cook should be in post at all times and all cooks must undertake specialist training in health and nutrition. Bedroom doors must not be wedged open as this compromises fire safety within the home. The shower room in the dementia unit must have remedial works carried out in order that it can be used. Decoration must take place to those areas of the home as identified in the report. A full employment history must be obtained for all staff who are employed to work in the home. Records must be maintained that confirms that all staff take part in regular fire drills and receive regular fire instruction as set out in the guidance issued by the Fire Authority. All staff employed in the home must within 14 days take part in at least 1 period of fire drills and fire instruction. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 8 In the absence of the manager a designated person must be in place to deal with the day-to-day management of the service. This position must be supernumerary to the rotas. 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. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 9 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 Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 10 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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment is completed prior to a place being offered in the home and this ensures that only those people whose needs can be met are admitted. Intermediate care is not provided. EVIDENCE: Residents’ files contained assessment information, which confirmed that an individual assessment of need had been carried out prior to admission into the home and from this the staff had developed written plans of care. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 11 The staff also received assessment information from the placing authority and this was used to determine whether an individuals needs could be met in the home. For those persons who have moved into the home on a temporary basis (respite care) and then decide to stay permanently an assessment of their needs is carried out on admission. Once the assessment process is completed the home write to the individual and /or their relative confirming that their needs can be met in the home. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Though written care plans are in place, these need further development to ensure that people receive care in a way that they prefer. Nevertheless, health care needs are effectively met and medication administration follows good practice. These ensure that residents’ general health and wellbeing are safeguarded and promoted. Furthermore, excellent staff interactions with residents confirms that residents are treated with dignity and respect at all times. EVIDENCE: Residents living at Appletree had individual written plans of care in place and information was being maintained about the individual residents health and personal care needs on these plans. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 13 Four care plans were viewed as part of a case tracking process which involved looking at all written records held on a resident and from this assessing how individual needs are being met. The care files contain risk assessments though some of these were not in date order or contained insufficient detail therefore making it difficult to retrieve information. For those that were fully completed they gave a good indication of what steps staff is taking to minimise risks to residents. Though each person has an individual care plan they do not contain sufficient detail to demonstrate the current practices carried out by staff to demonstrate how they are meeting residents assessed needs. One person has behaviours that challenge and at times this behaviour can result in aggression towards staff and others. A behaviour chart is in place but this does not include the detailed actions to be carried out by staff. And though there has been involvement from a community psychiatric nurse there is no record on the file to show what advice they have offered or whether they are involved in the care plan or not. Observations made confirmed that staff are very good at identifying what triggers this behaviour and have strategies in place to deal with this effectively. Whilst at the same time minimising any risk to the person and to others. Staff are also working in a positive manner with one person who has special dietary needs and are involving the resident in devising a menu that is nutritious and which also incorporates their choice of foods. Whilst at the same time not compromising this person’s special health needs. Discussion with the resident confirmed that they were very clear about the care plan and what staff was trying to do to support them. However the care plan does not include this positive work that is being carried out by staff and neither does it mention the specific dietary/health requirements of the person. The daily records which details of how residents spend their day are not always fully completed and do not offer enough detail to monitor a resident’s progress. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 14 There is no social history or background information in the care files to assist with the care process. Though in discussion with staff it was clear that they held a lot of information about a person’s background. Observations confirmed that they used this information effectively to assist with communication particularly when a resident became upset and unsettled. In discussion with the person in charge it was acknowledged that the care plans need revising as well as the daily records that are in use. In addition the record that is being used to record details of baths needs to be withdrawn. With records of bathing and personal hygiene incorporated into a care plan as part of person centred approach to care. Though there were shortfalls identified with the care plans and other associated documents it was clear from observations that individual residents needs are being met. And positive outcomes are being achieved. Records are in place that confirms visits by health professionals such as the GP, chiropodist and the community nurse. And discussion with residents confirmed that the staff are very good at calling in the doctor if they are feeling unwell. During the visit it was evident that staff address residents by the chosen form of address, and staff were respectful in their discussion with residents. Discussion with residents confirmed that the staff “were very good” and were always there to help you when needed. Personal tasks were carried out in the privacy of resident’s bedrooms. And staff ensured that that when health professionals were visiting they were able to see residents in their own bedroom. Prescribed medicines are administered by senior staff all of which have received accredited training in the safe handling of medicines. Good systems are in place to ensure that the residents receive their medicines safely and residents have signed consent forms authorising staff to administer medicines on their behalf. The staff orders medicines monthly and due to the guidance issued by the Royal Pharmaceutical Society some change is needed as to how the medicines are ordered. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 15 When staff order repeat prescriptions form the GP they are then sent directly to the dispensing pharmacist. Staff then checks medicines against the counterfoil of the prescription when the medicines are delivered to the home. Staff do not see the original prescription before it is sent to the pharmacist and they need to in order to ensure that no errors have occurred. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents lead fulfilling lifestyles through exercising choice and control over how they spend their day. People’s lifestyle is good with regular contact being maintained with relatives and friends however a qualified cook needs to be in place to ensure that the resident’s receive a wholesome appealing balanced diet. EVIDENCE: At the time of the inspection both chefs/cooks were absent from work. The kitchen assistant was cooking with help from a care assistant who was carrying out a kitchen assistant role. A new cook had been employed but due to honouring holiday commitments could not commence work for another week. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 17 Of the cooks who are employed the senior care assistant confirmed that they have not attended any specialist training on diet and nutrition. Two complaints were made in surveys about the food and two complaints were made about the food on the day of the inspection. The staff are aware of the residents dissatisfaction with some of the items on the menu though in the absence of the manager have not been able to make any changes. For one person who has to follow a special diet due to health needs staff have been positive in sourcing the correct ingredients. However none of the staff that is employed to cook have received any specialist training in diet and nutrition. One resident does not particularly like the main courses and there are certain foods they will not eat. This is not recorded in the care plan. Two choices were available for each meal and if required residents could choose an alternative to the meals on the menu. Observations indicated that most of the residents enjoyed their food. A meal was taken with the residents and though it was satisfactory it was not particularly tasty. One resident stated that the staff always ensures that they get their favourite ginger biscuits. In further discussion the residents confirmed that the absence of the cook was probably one of the reasons why the meals were not always satisfactory. The dining room was nicely set out with tablecloths on the table and the mealtime was unhurried. Staff gave assistance throughout the meal to those people who required support. The routines are flexible within the home with a number of residents choosing to spend their day in their own rooms or in the small lounge known as the coffee shop. Discussion with the residents confirmed that staff offers support so that they can follow their own routines. There are no restrictions on visiting times to the home and residents maintain contact with relatives and friends. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 18 There was good rapport between staff and visitors and the atmosphere was relaxed and welcoming. There were no activities on the day of the visit due to the hairdresser being in the home. An activities plan that was on display gave a list of the activities that were planned for the week. From all of the surveys that were received the residents confirmed that they enjoy the activities that are provided in the home. A record of activities is kept in each resident’s file and this confirms whether they have taken part or whether they have chosen not to. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear accessible complaints procedure gives residents and their relative’s confidence that they will be listened to and taken seriously. The staff has a good understanding of local adult protection procedures, which helps to ensure the protection of residents from abuse. EVIDENCE: One person made a formal complaint about the food and this is logged in the complaints record. Discussion with this resident confirmed that staff had responded quickly and were taking positive steps to deal with this. The resident confirmed that they were involved in developing a menu with staff and that staff had also purchased appropriate food products to assist with their special diet. These positive actions however are not recorded in the complaints record. The residents said that know who to complain to if they have any concerns. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 20 It was confirmed that staff have received training in the protection of vulnerable adults. And in discussion with staff it was clear that they are aware of the appropriate policies and procedures in place to protect residents from potential harm. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 21 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, 21 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, with some areas requiring decoration though the health and safety of staff and residents is being compromised by the wedging open of fire doors. EVIDENCE: This visit focused on looking at all communal areas, some bedrooms and the new extension that has been built since the last inspection. The home is clean and tidy with good standards of hygiene in place. A maintenance person is employed to deal with day-to-day minor repairs and on the day of the visit was carrying out a repair to the laundry room floor. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 22 The new extension, which is occupied by residents who have dementia type illnesses, has been built to a good standard. However the staff could not use a shower room that offers good disabled access as the water does not drain away correctly, and if used causes flooding to the corridor. The ground floor residential unit has torn wallpaper in a number of areas in the corridors, one bathroom door has a hole in the door panel. Where electrical wiring has been re-chased into the wall the paper has been removed and the handrails in one area are badly chipped and require painting. Discussion held with the senior person in charge confirmed that discussion has been held about the wallpaper and what remedial action needs to be taken. Four bedroom doors were wedged open using a variety of items, one of which included a small bedside table and this compromised the fire safety in the home. Following discussion with the person in charge at the time immediate steps were taken to rectify this. There were no noticeable safety hazards at the time of the visit. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to ensure that residents’ needs are met. And staff receives sufficient training to support them in their work, to ensure residents receive good quality care. Robust recruitment procedures are in place though an amendment is required to the application form. This will further ensure that all of the relevant information is received during the recruitment process, to prevent unsuitable people being employed. EVIDENCE: During the inspection there were sufficient staff on duty to meet the needs of the residents. With the exception of qualified catering staff that were absent from work. The kitchen assistant was carrying out the role of cook and a member of the care staff who was designated to work as a kitchen assistant supported them. Discussion with the senior person in charge confirmed that the rotas had been organised to ensure that there was safe staffing cover on all of the living units that are spread throughout the home. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 24 And if there were shortages then agency staff is used to ensure safe staffing numbers at all times. Though the training records were not seen during the visit these were submitted to the commission following the inspection and these confirmed that there are good training opportunities for staff. In the staff surveys staff confirmed that they are satisfied with the training that they receive. All staffing files for the most recent employees were looked at. For all but three persons the record of previous full employment history was not recorded in detail. The application form asks that any applicant list employment history for the last 10years only and this would make it difficult therefore to have a full employment history since leaving full time education. The lack of any dates for education establishments attended also makes it difficult to establish when a person first begun employment. Discussion with the administrator confirmed that a lot of work is carried out before employing someone to work in the home and this included taking up the necessary references and police records check. However there was a recognition that the application form needed to be developed further in order to meet the requirements of the Care Homes Regulations 2001. This would further tighten the process of staff recruitment. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 25 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Experienced senior staff is ensuring that the service is effectively run in the best interests of the residents; that they are safe and well cared for and their rights are safeguarded, while the manager is on sick leave. However the absence of regular fire drills and fire instruction can put residents and staff at risk. EVIDENCE: The acting manager who is not yet registered is on sick leave and had been for 3 weeks. In her absence the management function of the home was delegated Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 26 to 3 senior staff that are responsible for the management of the home when on shift. And external management support has been available to the seniors in the absence of the manager. From these three workers no one has been designated as the sole person in charge of the management function. And this at times has limited the effect that they can have in making decisions about the management of the service. In addition to this the senior person is not supernumerary to the rotas and also has to carry out other tasks in addition to giving management oversight to the staff. The current management situation was discussed with the regional manager who at the time of the inspection confirmed that the acting manager would be off work longer than expected. As a result of this it was stated that one of the senior carers would be designated as the person in charge. And will have sole responsibility for the day-to-day management of the home until the manager returns from sick leave. This role will be supernumerary to the rotas with the senior person carrying out management tasks only. Despite the absence of the manager and the current absence of the catering staff, the senior care staff has worked hard to maintain standards in the home. As previously stated staff had responded to a complaint promptly and taken immediate actions to rectify this. The senior staff had ensured that staffing levels were maintained for the safety of the residents and had made sure that activities continued to be provided. Good records are in place for the management of resident’s personal allowances. The home also carries out there own regular internal audit to ensure that staff are following the correct procedures and if there are any errors they can be dealt with immediately. Monthly staff meetings are held and staff confirmed that they receive regular supervision. Observations made confirmed that staff carries out their practices in a professional manner. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 27 Good records are maintained of accidents and this lists the actions taken and how people are supported after having an accident. However the records that related to fire drills and fire instructions do not offer sufficient information, and the records do not demonstrate how staff ensures the safety of residents in the event of a fire. The last fire drill record was written on a piece of blank paper and dated as 31/01/08, it offered no indication as to who carried out the drill and what response was made by staff. The last fire instruction record was shown as taken place on 1/05/07. One staff member in discussion confirmed that they had not taken part in any fire drills and they have been employed in the home for 1 year. Another member of staff in discussion stated they had been employed since November 2007 and had not taken part in a fire drill. In the fire records that are maintained there was no evidence to show that staff are receiving the regular 6 monthly fire instruction/and drills. There was no evidence to show that night staff is receiving three monthly fire instruction. There is no evidence of new staff receiving two periods of fire instruction in their first month of employment. There are 3 fire notices (what to do in the event of a fire) on display in the entrance lobby. Each one is different and gives slightly different instructions, one refers to the nurse in charge and another advises staff to fight the fire. All matters relating to fire safety were discussed with the senior in charge and an immediate requirement was made. It was clear from discussion with the senior and also the staff on duty that they knew what actions should be taken in the event of a fire. The senior in charge was aware of the different fire zones in the building and knew how to operate the fire alarm panel. On the second visit to the service work had commenced in ensuring that all staff had taken part in a fire drill and had also received a period of fire instruction training. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 28 Arrangements were also being made for all staff to receive updated refresher training on fire safety. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Residents care plans must include detailed information to demonstrate how staff is meeting assessed needs. For those residents who have behaviours that challenge. The risk assessments must be updated to demonstrate the positive interventions that staff carries out. Staff must see sight of the original prescription issued by the GP with a copy being kept in the home before it is sent off to the pharmacist. Medicines must then be checked against this copy prescription when delivered to the home. (Immediate) An experienced cook should be in post at all times. And all cooks must undertake specialist training in health and nutrition. This will ensure that they have a good understanding of those residents who have special dietary/health requirements. Timescale for action 31/12/08 2. OP7 15 31/10/08 3. OP9 13 (2) 07/08/08 4. OP15 18 (c) i 31/10/08 Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 31 5. OP19 OP38 23 (4) (a) Bedroom doors must not be wedged open with anything other than guards that are approved by the fire authority. Remedial action must be carried out to the shower room so that it can be used. And all repairs as identified in this report must be addressed. 31/10/08 6. OP29 7, 9 & 19 Schedule 2. 23 (4) (d) 7. OP38 All information as required by 07/08/08 regulation must be obtained when recruiting staff to work in the home. (Immediate) All staff must take part in regular 07/08/08 fire drills and receive regular fire instruction as set out in the guidance issued by the Fire Authority. And records must be maintained to confirm this. (Immediate) A designated person must be identified to manage the service whilst the manager is absent from work. This position must be supernumerary to the rotas. (Immediate) 07/08/08 8. OP38 18 (2) (a) 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 More detail should be recorded in the daily records in order to assist staff when evaluating care plans. The bath sheets should be withdrawn from use with records of personal hygiene being added to the care plan. Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Appletree Care Home DS0000061010.V371659.R01.S.doc Version 5.2 Page 33 - 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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