Inspection on 12/07/06 for Apperley House

This inspection was carried out on 12th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apperley House 04/02/08

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Apperley House 97 Gloucester Road Tewkesbury Glos GL20 5SU Lead Inspector Mr Richard Leech Key Unannounced Inspection 12th & 13th July 2006 09:45 Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 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 Apperley House DS0000066470.V303679.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 Adults 18-65. 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. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apperley House Address 97 Gloucester Road Tewkesbury Glos GL20 5SU 01684 292658 TBA 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) www.aspirationscare.com Aspirations Care Limited Miss Johanna Russell Care Home 10 Category(ies) of Learning disability (10), Physical disability (6) registration, with number of places Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care and accommodation for up to ten service users with a learning disability and up to six people with physical disabilities. The total number of service users who may be accommodated is ten. N/a Date of last inspection Brief Description of the Service: Apperley House opened in Spring 2006. It aims to provide care and accommodation for people with learning disabilities who may also have physical disabilities and complex needs. The home has two floors, each with a kitchen and lounge. All bedrooms have individually adapted en-suite facilities. There is a large garden and a patio. Apperley House is located in a residential area of Tewkesbury. At the time of the inspection there were two vehicles used to support people to access activities in the community and to visit family. In the pre-inspection questionnaire fees were recorded as ranging between £1328 and £1741 per week. Prospective service users and people involved in their care are provided with written and verbal information about the home including copies of the Service Users Guide and Statement of Purpose. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Wednesday from mid-morning to late afternoon. A second visit was made the following day from about 10.30 to mid-afternoon. During this time service users and staff were met with. The manager was present throughout the visit. Records checked included samples of care plans, risk assessments, daily notes and health and safety documentation. The manager provided a tour of the building. A separate visit took place on July 14th 2006 by the pharmacist inspector. Their findings are included in this report. Medicine stocks and storage arrangements, Medication Administration Record (MAR) charts and other records and procedures relating to medication were looked at. The deputy manager and one other member of staff were spoken to. The inspection took place on a Friday morning over a 3 ¾-hour period. NB: Quality ratings of excellent cannot be given to new service at the first inspection since a sustained track record is required for this. What the service does well: A number of positive comments were made through survey cards. These included: ‘the surroundings/environment [are] conducive to establishing an excellent home…’ ‘recommendations..received well and immediately put into practice’ ‘provides a very high standard of care’ ‘the home is 100 first class run by excellent managers…nothing is too much trouble’ Admissions procedures and practiced help to ensure that people are only offered a place if the home is confident of being able to meet their needs. Good care planning and risk assessment frameworks are in place. Good procedures and practices are also in place for communicating with service users, with further work planned. Appropriate activity programmes are being built up for the service users. Where there are barriers to social and community inclusion there was evidence of attempts to address this. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 6 People’s dietary needs are met. Appropriate support is provided for meeting people’s personal and healthcare needs. There is a range of safeguards to help protect from the risk of harm and abuse. The environment is pleasant and homely, with suitable aids and adaptations being fitted according to people’s needs. Health and safety and infection control issues are well managed. Service users are supported by a caring and skilled staff team who are receiving good inductions and are engaged in ongoing training. What has improved since the last inspection? 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. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good admission procedures help to ensure that people’s support needs are identified as clearly and fully as possible before they move in to the home. EVIDENCE: As the home had just opened all of the service users were newly admitted. At the time of the visit some people had been living in the home for several months and others for a few weeks. Preparations were being made for other people to move in shortly. The manager described the admissions procedure, including assessment, gathering background information, visiting the person and arranging visits to the home (for a meal, or longer stays in some cases supported by familiar staff). The admissions policy was viewed. Two service users’ files were checked. These contained detailed and relevant background and assessment material as well as information from relatives. There were also assessments and accompanying proposals for the provision of care from the organisation. Staff spoken with confirmed that service users had visited the home before moving in, usually on several occasions. They described how they had been made aware of service users’ needs before they moved and given considerable support once the person was living in the home, helping to give them the confidence to work with the person from the outset. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good care planning framework is in place which will provide the foundation for documenting people’s individual support needs and for promoting consistent practice. Service users are supported to make choices using appropriate communication methods, respecting their individuality and helping them to feel empowered. A suitable framework for assessing and managing risk is in place, forming the basis of good practice in this area. EVIDENCE: Two people’s care plans were looked at in more detail. It was accepted that, as people had only recently moved in, these remained work in progress and continued to evolve. Some interim care plans were seen to have been put in place to deal with particular issues as they arose. Staff had signed to confirm that they had read the plans. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 10 The care plans seen were clear and covered appropriate areas. There was evidence of regular review, and of more wide ranging review meetings taking place with others involved in the person’s care being invited. Documentation demonstrated that complex issues around consent were being considered. Observation data and other information such as fluid intake were being gathered where relevant. The manager said that communication profiles would be developed for each service user. There were also plans to introduce some additional personcentred care planning tools in due course. Staff described good communication within the team and said that they were made aware of changes to care plans. Further evidence of this came from the communication book. Staff talked through how they offered choices to service users according to how each person communicated, giving clear examples. People spoken with demonstrated a commitment to empowering service users as far as possible. Service users’ files included a section entitled ‘restrictions’ where any major limitations of people’s freedom were documented and justified. Most areas of the home were seen to be freely accessible to service users, with the exception of places assessed as presenting significant hazards such as the laundry. Service users were seen choosing where to spend time. The manager described some specific complex issues around care planning, choice and risk. There was evidence of a thorough multi-disciplinary approach involving all interested parties. The home has a policy on risk taking which promotes the taking of assessed risks as part of enhancing people’s quality of life. Examples of risk assessments were seen which corresponded to this philosophy, for example promoting community access and the development of new activities. It was suggested that risk issues could be more clearly identified and assessed in some cases, although it was accepted that this was work in progress corresponding to a quickly changing situation and that they were identified in other formats such as review notes. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place to offer appropriate activities in the home and community as far as possible, promoting people’s quality of life and inclusion. Where barriers exist these are explored and plans made to address these in consultation with all relevant parties. Contact with family is promoted, allowing service users to maintain and develop relationships which are important to them. Routines in the home are flexible and staff have awareness of people’s rights and individuality, promoting a culture where people are valued and respected. Service users’ dietary needs are met, promoting their health and wellbeing. EVIDENCE: Care plans included reference to activities and to inclusion in the local community. One person whose care was tracked had a programme which included new activities such as swimming. Staff reported that, after some Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 12 initial anxiety, the person was enjoying this and benefiting hugely from it. Daily records provided evidence of the person taking part in a range of appropriate activities in the home and community. Discussion with the manager and checking of care plans and assessments provided evidence that people’s spiritual and cultural needs were being considered, for example around religious issues. At the time of the inspection the home had two vehicles. The manager and staff reported that this was adequate but that this may need review as more people moved in. The manager and staff reported some complex issues in relation to activities and community inclusion. Again, there was evidence of a thorough goalorientated approach involving all relevant parties and with consideration of risk issues and duty of care. Multi-disciplinary work was taking place to try to address barriers to social inclusion. Discussion with the manager and staff along with observation, care plans and daily records provided evidence of very close relationships with family members. Comment cards and discussion with relatives provided much positive feedback about the service and about the efforts of the team to facilitate regular contact. A letter was seen on file from a family member praising the team and the care provided. Care plans were seen to include reference to independent living skills and involving service users in tasks where appropriate. As noted, service users were seen moving freely around the home and exercising choice about where they spent time. Where people needed support to mobilise staff described recognising indications that they wished to move/change position. Staff also described flexible routines based on individual needs and preferences as far it was possible to identify these. Examples of this were observed over the course of the visit. Care planning files recorded people’s preferred form of address. However, staff were heard using various terms such as ‘darling’, ‘good girl’ and ‘sweetheart’. Staff spoken with demonstrated awareness of people’s rights and individuality. They and the manager described some complex scenarios around rights and best interests. Evidence was seen of these taken through appropriate channels (including consultation) and of them being documented and reviewed. Food records were seen, providing evidence of a varied and balanced diet. Staff described recognising and accommodating people’s preferences. Care plans described specialist needs in this area and observation during mealtimes provided evidence of these being met. Staff demonstrated awareness of risks such as choking and of the importance of posture when eating. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided to meet people’s personal care needs. Frameworks and specialist support networks are in place or are being developed in order to meet service users’ complex healthcare needs. Arrangements are in place for the management of medicines but there are aspects where improvements and more attention to detail are needed in the interests of service users’ safety and wellbeing. EVIDENCE: Care plans referred to how personal care was delivered. Staff demonstrated awareness of these plans and of issues around people’s privacy and dignity, giving examples. Staff also described respecting and recognising people’s choices as far as possible, balancing this with identified risks. There was evidence on file of complex issues around personal care being discussed and agreed as necessary. Discussion with staff about this provided evidence of basic personal care needs being met and of a clear plan to further build on progress made. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 14 Some monitoring devices are in use where there is an assessed need to check remotely on people’s wellbeing. Protocols for their use were seen in care plans. The manager described plans for a more sophisticated monitoring system to be installed, adding that she would hold the keys for each room’s mechanism to ensure that they were only used where there was assessed as necessary. Protocols will need to be devised about use of the new system with regard for people’s privacy and dignity. On the second day of the inspection a meeting with physiotherapists from CLDT teams was arranged to discuss specific issues around passive movement and posture for some service users. Such input is recognised as vitally important to meeting the complex physical needs of some of the service users living in the home and will be an ongoing process. Care plans viewed also made reference to relevant healthcare issues. Service users’ files, along with discussion with the manager and staff provided evidence of input from a wide range of health and social care professionals according to people’s needs. In some cases referrals had been made and a response was still awaited. Hospital assessments had been created based on a local person-centred format. This is good practice. The manager also described plans to devise health action plans for each person once there was time to work on this. Given service users’ complex healthcare needs and communication difficulties this will be an essential piece of work, but it is recognised that this will take considerable time and coordination. The home has a statement about the management of epilepsy. Individual care plans, protocols and recording formats were in place where appropriate. There is a medicine policy and procedures that staff have signed to say they have read. Staff have training about the safe handling of medicines. Part of the training should include an assessment of staff competence in practice of handling and recording medicines. Some medicines require specialist administration for which some training is provided. As these are delegated clinical tasks there must be proper assessment and delegation for care workers to carry this out. The responsible healthcare professional must be satisfied that the care worker is competent to carry out the task. CSCI publish advice about training care workers to safely administer medicines and this could help to review what is happening in this home. There is a homely remedies protocol. Staff are requested to use some different items by the families. This needs writing in the care plan with information about checks made with the doctor or pharmacist that these are safe to take with medicines already used. There was safe storage for medicines that was clean and no excess stocks. The paint pots must be removed from the medicines room. The locked container for medicines in the fridge should be fixed to the shelf. The date Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 15 should be written on medicines when first opened, as this can also be a useful way to audit correct medicine use as well as showing they are not used beyond the recommended shelf life. There was no date on the one eye drop container in use. Continued need for the product was due for review with the doctor shortly after the inspection. A local pharmacy provides medicines in a monitored dose system (MDS) with printed Medication Administration Record (MAR) charts once residents are established in the home. The times on the MAR charts showing when medicines are administered need to reflect the actual times given. The allergy box needs completing even if this is ‘none known’ so that this important information is available. Some handwritten entries are incomplete and not always signed. A signed second check is needed to confirm the correct details are copied. Arrangements for medicine records when residents are first admitted need improving. Records for two recently admitted people were incomplete with some wrong information. Some medicines given to the home to use on admission were not labelled. Appointments to see the doctor and register the residents with a local doctor were in place. The use of an eye drop for one person was not clear and it may have been provided to the home when it was beyond its ‘use by’ date. When residents are admitted prompt arrangements are needed to check the correct medicines that are needed and medicines only accepted to use if in original containers as properly labelled by a pharmacist. Some protocols for use of ‘as required’ medicines are in place (an emergency medicine to give as a rectal solution and a laxative enema) but not for all medicines used ‘as required’ (an inhaler for example). Some protocols may need reviewing, as they are from previous placements so the home need to be sure they are current. There are systems in place to record all medicine brought into and leaving the home. Records for receipt of a few medicines had been missed. When medicines are taken out of the home for periods of leave records should be made and for any medicines subsequently returned. Lunchtime doses were seen as given appropriately and residents made aware that they were having their medicines. Care plans need to reflect residents’ consent to staff giving them their medicines. Staff described how they gave medicines to a particular resident with swallowing problems. Where residents have difficulty in swallowing a clear plan is necessary describing how medicines are given and how residents are aware that they are taking their medicines. When this involves crushing the medicines to put in food a clear plan, drawn up following multi-disciplinary consultation that this is safe, appropriate and in the best interests of the resident, needs to be in place. Patient Information Leaflets (PILS) are available as a reference to staff about the medicines they are handling. A recent edition of the British National Formulary is advised as a standard record book. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good (although some issues around service users’ finances require attention). This judgement has been made using available evidence including a visit to this service. Appropriate arrangements are in place which help service users to express concerns and dissatisfaction and for these to be addressed. Measures in place which help to protect service users from harm and abuse, although some aspects of the management of service users finances need clarification. EVIDENCE: Care plans referred to how people communicated, including expressing unhappiness. Staff spoken with demonstrated awareness of this, giving examples and talking through how they responded. There are text and symbol versions of the complaints procedure. It is recognised that service users are unlikely to raise a formal complaint directly and that they will be reliant on staff and others advocating on their behalf to identify signs and dissatisfaction and address the possible causes. There is a complaints form for relatives and friends. Through comment cards and direct discussion family members expressed confidence about raising concerns and complaints and that these would be appropriately handled. Some people indicated that they were not aware of the home’s complaints procedure. It may therefore be appropriate to ensure that all relevant parties have copies of the procedure/leaflet. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 17 The home has policies covering whistle blowing, adult protection and abuse. A copy of the ‘No Secrets’ paper was also on file. Staff spoken with indicated that they would report any concerns and that they would be confident that any such issues would be handled appropriately. Some staff were asked about possible indicators of abuse and demonstrated awareness of signs which may suggest an adult protection issue. Senior staff reported that they had recently attended training about adult protection. This is good practice. The manager said described plans for all staff to attend this training as soon as possible. There is some coverage during induction. Selected records of service users’ finances were checked. Receipts were seen to correspond to entries on records. However, there was not always an indication of which staff member had been involved in the purchase. The manager said that staff should sign the receipts. The information could also be recorded on the spreadsheet where all financial transactions are entered (through the addition of an extra column). Cash balances checked corresponded to records. The manager said that there was a system of regular balance checks, although these were not being recorded. This should be done. One receipt showed that a loyalty card had been used. The manager said that there were no in-house loyalty cards, suggesting that it belonged to a staff member. Staff must not profit from transactions involving service users’ money. Records showed that many service users had purchased fans for their room. One person’s record showed that they had also bought a fan for communal areas. The manager said that this fan was taken with the person around the home, and related to a specific need around temperature regulation. As an assessed need it could be argued that the home should cover the cost of this/of all fans in communal areas as opposed to bedrooms. The fan was also observed being used by others and being left in areas when the service user had moved on. It was suggested that the home could consider fitting ceiling fans for use in hot weather. It was noted that some service users had paid for bedding. The manager said that the home provided basic bedding but that any additional personalised items would be paid for by service users. However, one person had paid for a basic duvet on 29/06/06. The manager said that the home should have paid for this. One person had paid for some paracetamol on 12/06/06. It was not clear from documents seen who is expected to cover the cost of over-the-counter remedies. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 18 Greater clarity is needed about which costs are covered by the home and which by service users, along with clearer guidance for staff. This is necessary in order to ensure as far as possible that the policy is fair, consistently applied and transparent. It was not possible to directly ascertain whether service users were in receipt of their personal expenses allowance from the records viewed in the home. The manager expressed confidence that each person was in receipt of significantly more than this through purchases made on their behalf. Nonetheless the team should begin to consider how it can be demonstrated/evidenced that people are in receipt of this allowance as a minimum. However, it is recognised that the home is still becoming established and that the service users and their families are undergoing major life changes. As such it is accepted that resolution of this issue may come down the line. Robust safeguards around the operation of service users’ accounts were described by the manager. The manager said that restrictive physical intervention would not be used in the home and that there were therefore no plans to provide training in this area for staff. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, homely and suitably adapted environment is provided, promoting service users’ comfort and wellbeing. EVIDENCE: All communal areas and most of the bedrooms were checked. Bedrooms were seen to be personalised, pleasantly decorated and fitted with appropriate aids and adaptations. Appropriate measures were in place to protect people’s privacy and dignity. All rooms have en-suite facilities. These had been adapted according to the needs of the person who had moved into the bedroom. A gate was in operation on the landing. The manager described the reasons for this and when it was used. This was seen to be on a risk assessment basis and with the least restrictive practice employed, the gate being locked only for brief periods at night when the two staff are engaged downstairs. The manager was aware of the need to monitor this to ensure that practice remained as unrestrictive as possible within the context of appropriate risk management. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 20 Fire doors to the dining room, lounge and office were seen to be propped open. The manager was aware that these doors need either to be kept closed or fitted with automatic closing devices linked to the alarm system. Quotes were being obtained. A requirement is therefore not made on the understanding that this is being addressed. Understandably, some rooms were still being finished off. The manager described plans to turn one room into a sensory room once priorities such as decorating bedrooms in advance of people moving in was completed. Some work was taking place at the time of the inspection, for example, fitting new flooring and shelving. Staff described how they managed the risk of infection through hygienic practices including the use of protective clothing/equipment. Many staff had already undertaken a detailed infection control course. Information about infection control was available in the office. The laundry and kitchen were seen to be clean and hygienic, with adaptations such as fly screens fitted in the latter. All other areas of the home appeared clean. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are committed and skilled, promoting high quality, consistent care. Appropriate structures and safeguards are in place around recruitment and selection, helping to protect service users. Suitable training is being provided or is planned in order to equip staff with the knowledge and skills that they require to meet service users’ complex needs. EVIDENCE: According to information on the pre-inspection questionnaire just under 50 of care staff have NVQ in health and social care at level 2 or above. Staff spoken with demonstrated knowledge of people’s care plans, needs and specialist conditions, although there were some areas where people felt that they would benefit from more training (see training section). The manager had compiled information on a range of different areas of relevance to working with people with learning disabilities and this was readily accessible to staff in the office. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 22 Interactions between staff and service users were observed to be warm and respectful. Staff interacted primarily with service users, communicating with colleagues in a professional manner. Staff spoken with demonstrated a strong value base and a commitment to creating a high quality and person-centred caring environment. Staff described how they communicated with service users, employing a range of techniques and tools, evolving as their knowledge of each person grew. It is planned to create communication profiles for each person. This is good practice. Training had not yet been provided in ‘total communication’, although the manager said this would take place. Four comment cards were returned from health and social care professionals. All provided very positive feedback about the service, management and staff team. There was evidence of good working relationships with outside professionals and of advice and recommendations being acted upon. The organisation has a recruitment and selection policy including reference to equality of opportunity. Selected staffing files included appropriate documentation being obtained. Some staff had been recruited on a Pova-first basis. The manager explained the circumstances and was aware that this should not routinely happen. Detailed, individualised risk assessments had been put in place for staff recruited in this way pending return of their full CRB check. This was accepted on the understanding that recruitment on this basis in future is in exceptional circumstances only, rather than becoming routine practice. Records showed that many staff had already received training in key areas such as moving & handling, fire safety and medication. Some gaps in mandatory training were noted, but a clear framework was in place to address this and it is accepted that this relates to the service being newly opened. The manager said that mandatory training was being prioritised, and discussed plans for other specialist training according to service users’ needs (also referred to in the pre-inspection questionnaire). Some in-house training was being provided by the manager, such as about epilepsy. Staff spoken with felt that this training had equipped them with appropriate knowledge and skills in this area. Staff spoken with also demonstrated awareness of issues such as pressure care. Specialist training and guidance will be of vital importance in meeting the needs of people with profound and multiple disabilities. The manager recognised that this will be an ongoing process as service users move in and also as new staff join the team and established staff require refreshers and updates. For example, one person due to move in soon after the inspection had specialist needs around feeding for which staff will require training. Training provision will be revisited during future inspections. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 23 On the second day of the inspection a physiotherapy teaching and training sessions was taking place in the home specifically based around individual service users’ needs and conditions. Some relatives had been involved in training staff. This is good practice, recognising and valuing their knowledge, skills and continuing support. The organisation has a training coordinator who also oversees the induction (based on skills for care standards). Staff spoken with were positive about their induction programmes and felt that they had been well equipped for their roles, as well as having access to ongoing support. The manager and deputy conduct supervision meetings. At the time of the inspection it was noted that some staff had not yet received formal supervision, contrary to the organisation’s supervision policy. Whilst it is accepted that there are many competing priorities at such as an early stage, a comprehensive system of formal supervision will need to be developed. This will also be revisited during future inspections. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, promoting positive outcomes for service users. Appropriate frameworks are in place for monitoring and improving the quality of the service. Health and safety is well managed, promoting staff and service users’ wellbeing. EVIDENCE: The manager is a registered nurse. Since qualifying she has worked with people with learning disabilities and in 2001 became manager of a home for people with learning and physical disabilities. She obtained the Registered Manager’s Award of 2003. The manager gave an example of taking necessary action in relation to staffing issues in order to promote best practice at all times. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 25 There is management structure, with a registered manager, deputy and a team of seniors. Positive feedback was obtained from staff and through comment cards about the management of the home. Staff felt well supported, that their ideas and input were valued and that the manager was approachable. Those spoken with unanimously felt that the home was well run. The organisation has a policy covering quality assurance issues. A structure is in place. This includes 6-monthly staff questionnaires (which go directly to the directors), an annual relatives survey and a bi-annual self-evaluation. Templates for each were seen. Detailed regulation 26 reports are being received regularly. At the early stage in the home’s development it was not possible to comment on the quality assurance system other to say that a framework was in place. Evidence of its effectiveness will be looked for in future inspections. Staff spoken with felt that their health and safety was promoted. They described receiving training and instruction around manual handling and the use of the equipment in the home. They confirmed their understanding of the Coshh policy and said that training had been provided in this. The manager described servicing arrangement for specialist equipment. As noted some automatic closing devices are due to be fitted. At one point the laundry was seen left open and unattended, with a chemical spray on a work surface. This will need to be monitored to ensure that staff follow procedures and that service users are not placed at unnecessary risk. Information about various health and safety issues was available in the office. This included information about food safety, first aid, continence, infection control and fire safety. There was also a dedicated health and safety file containing policies and procedures and relevant information. The home is obtaining medical device alerts. At the time of registration evidence was supplied of appropriate checks on gas and electrical appliances. Records provided evidence of fire alarms and emergency lighting being tested at suitable intervals. Information was received in June 2006 that a fire officer had visited the home and was satisfied with the fire safety measures in place. Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/a 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 2 Standard YA23 YA23 Regulation 12 (1) & (5). 13 (6) 5 (1) 12 (1) Requirement Staff must not use their own loyalty cards for transactions involving service users’ money. Fully clarify the policy about which costs are covered by the home and which by service users. Ensure that staff are aware of this. As part of the above establish if any service users are due for a refund in respect of purchases which they have paid for which the home should have covered. Timescale for action 31/07/06 31/08/06 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 3 Refer to Standard YA16 YA19 YA20 Good Practice Recommendations Consider the terms of address being used in some cases, as described in the text. Create health action plans for each service user. • Review arrangements for handling medicines to make sure that: • Residents’ consent to medication is obtained and written in individual plans; include situations where medicines may be crushed and given with food; DS0000066470.V303679.R01.S.doc Version 5.2 Page 28 Apperley House 4 5 YA22 YA23 Arrangements and records for dealing with medicines when residents are first admitted are improved; • Handwritten entries on MAR charts are signed and dated with a second signature to indicate a check of accuracy; • Records are made of medicines given for periods of leave and any subsequently returned; • The locked container for medicines in the fridge is fixed to the shelf; • There is proper assessment and clinical delegation to staff to give medicines by specialist methods; • The date is written on medicines when first opened to use; • There are up to date protocols for each resident describing how to use any ‘as required’ medicines; • There is access to a recent edition of a medicine reference book such as the British National Formulary. Ensure that all relevant parties have copies of the complaints procedure/leaflet as noted in text. Staff should sign receipts as per the home’s policy where they are responsible for a transaction involving a service user’s money. The information could also be recorded on the spreadsheet where all financial transactions are entered. Consider how it can be demonstrated/evidenced that service users are in receipt of their personal expenses allowance as a minimum. Record the balance checks that are regularly conducted on service users’ finances. Consider whether it may be appropriate to fit ceiling fans in certain locations in the home for use during hot weather. • 6 YA24 Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 Apperley House DS0000066470.V303679.R01.S.doc Version 5.2 Page 30 - 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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