Inspection on 04/02/08 for Apperley House

This inspection was carried out on 4th February 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apperley House 12/07/06

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 11:00 – 18:55 & 10:15 – 4 & 5 February 2008 13:40 th th Apperley House DS0000066470.V354802.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.V354802.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.V354802.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 01684 293795 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.V354802.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. 10th January 2007 Date of last inspection Brief Description of the Service: Apperley House opened in Spring 2006 and is located in a residential area of Tewkesbury. 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. 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. Up to date information about fees was not obtained on this occasion. Apperley House DS0000066470.V354802.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 3 star. This means the people who use this service experience excellent quality outcomes. The home was visited twice, on a Monday and a Tuesday in early February. We did not tell the home that there would be a visit. Before the visits took place the manager completed an Annual Quality Assurance Assessment (AQAA) providing information about the service. Surveys were also sent out to people with an interest in the home and the response rate was good. Some people were also spoken with on the telephone. During the visits different records were looked at including examples of care plans, healthcare notes, risk assessments, daily records, medication charts, training information and staffing files. Discussion took place with the manager and several members of staff. General observation of life in the home took place, including some mealtimes. What the service does well: When people are referred to the home the assessment process is very thorough. This helps to ensure as far as possible that the service will be able to meet the needs of people who are offered a place. The service has a comprehensive approach to care planning. This results in people’s needs, goals and choices being recognised and responded to as far as possible. Staff are skilled at communicating with the people they support. Risks are clearly identified and managed, helping people to lead full lives. People are supported to lead busy and active lives as far as possible, and to stay on touch with family and friends. Routines in the home are relaxed, flexible and individual. People’s dietary needs are met, and their preferences taken into account. Menus are healthy, varied and balanced. Appropriate personal and healthcare care support is provided. There are good links with healthcare teams in the community. Sound arrangements are in place for handling medication, helping to ensure that people stay safe and well. People with an interest in the service feel able to raise concerns and complaints. They are confident that they will be listened to. Staff are good at Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 6 responding to non-verbal indications of distress and discomfort, helping to ensure that the people living in the home also feel listened to. Measures are in place which help to protect the people living at Apperley House from harm and abuse. There is a good framework for recruitment and selection, helping to further safeguard people. Apperley House is clean, homely and welcoming. People have the aids and adaptations that they need. Bedrooms are bright and personalised. There are a number of shared spaces including a well-equipped sensory room. The home is well run. The manager is knowledgeable, approachable and works in a very hands-on way. There is a clear management structure. Staff have the appropriate knowledge and skills to meet the complex needs of the people living in the home. They are supported by a good training programme. There was considerable positive feedback from people with an interest in the service. 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. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 7 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. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 8 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.V354802.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The assessment process is very thorough, helping to ensure as far as possible that the service will be able to meet the needs of people who move in. EVIDENCE: The admissions policy was seen. This provided a sound framework for the admissions process. Actual practice was checked in relation to one person who had moved in during 2007. The manager confirmed that several people had not been accepted for admission, outlining the reasons, providing evidence of a commitment to ensuring that the service is appropriate for the people who move in. The directors of the organisation check referrals. Initial assessments are made and, if it is felt that their needs can be met, a care proposal is put forward. The proposal for the person who had most recently moved in was looked at. This showed that there had been many assessment dates involving the person, their family and others in a position to contribute. The assessment was seen to be very thorough. The placing authority had provided a care plan prior to the person moving in. The file included other relevant background information and documentation. A copy of the residency agreement was seen on file. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 10 The manager and staff confirmed that the person had made several visits to Apperley House before moving in, and that their family had also visited. This had included overnight stays. A family member confirmed that this had been the case. They were very positive about the assessment and admission process and about how their relative had been helped to settle in. A review had taken place in the home in September 2007, a few months after the person had moved in. This indicated that the person had settled well and provided a good summary of events and issues to date. A letter dated October 2007 from a healthcare professional who had known the person in their previous setting indicated that the move had gone well. This included the comment, “please thank your staff for the efforts they made to ensure that [service user’s] transition…was as easy as possible…it has been greatly appreciated”. Review notes from November 2007 noted that the person was ‘happy and settled’. The manager and staff felt that the admission was appropriate and they the service was able to meet the person’s needs. The manager said that she had been involved and consulted around the time of assessment, though had first met the person when they came to the home for a meal. There was discussion about the possibility of having more direct involvement at an earlier stage. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 11 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. 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. The service has a comprehensive approach to care planning. This results in people’s needs, goals and choices being recognised and responded to as far as possible. Risks are clearly identified and managed, helping people to lead full lives. EVIDENCE: Care plans for two of the people living in the home were sampled. These followed a format based around needs, objectives and resulting actions. They were seen to be clear and up to date. Care plans covered relevant areas such as mobility, personal safety, continence, independent living skills, activities, relationships and emotional needs. There was also detailed information about how the person communicated and around behaviour support. Care plans made reference to identifying people’s preferences and choices as far as possible, and to promoting independent living skills. Any identified Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 12 restrictions were noted accompanied by the reasons. An assessment had been done around the person’s capacity to contribute to the care planning process and resulting best interests’ decisions. Work had begun on implementing a more person-centred care-planning tool, using photographs. Through discussion staff were able to demonstrate good knowledge of people’s care plans and of associated needs and conditions. Staff gave examples of how they offered people choice as far as possible, and were seen ascertaining and respecting choices where possible during the visits. Observation of day to day life in the home also provided evidence of care plans being followed, such as around communication needs and mobility. Risk assessments were sampled. These covered significant areas such as road safety, use of kitchen equipment, eating & drinking and mobility. Discussion with staff provided evidence of the outcomes of these assessments being followed. The service has a risk-taking policy which refers to people’s rights and to the taking of risk potentially being positive. Whilst most daily notes were seen to be sufficiently detailed and descriptive, there was a discussion with the manager about some entries. This included occasions where nothing was recorded for some meals, and where a more objective description was needed rather than phrases such as “[service user] messed…room up this evening” or “bit naughty”. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are supported to lead busy and active lives as far as possible, and to stay on touch with family and friends, promoting their quality of life. Routines are flexible and individual and people’s rights are upheld, helping to ensure that people feel valued and respected. People’s dietary needs are comprehensively met, and their preferences taken into account as far as possible, enhancing their wellbeing and enjoyment of their food. EVIDENCE: Activity records along with observation and discussion with staff provided evidence of people having full and active programmes as far as possible. One person’s condition was resulting in them not being able to take part in their Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 14 usual activities. Staff described how they were attempting to stimulate the person in the meantime, including activities in the home and community. Another person was likely to be experiencing a significant change in their daily routine and activity programme during 2008. The manager and staff described how they were planning for this, attempting to make the transition as smooth as possible. Discussion and records provided evidence of the person being introduced to a wide variety of new activities. During the visits to the home people were seen going out and about, with busy, individual programmes. Evidence that people were supported to stay in contact with family and friends came from observation, discussion with the manager and staff and also from records. In addition, family members completed survey forms and there was some telephone contact. Feedback from relatives was very positive. Comments included that, “care…is superb” and that the home provided “brilliant care”. As noted, there was evidence of family being appropriately involved in the assessment process before people moved into the home. Files noted people’s preferred form of address. Staff were observed to interact with the people living in the home in a very respectful and sensitive manner, and to be highly conscious of privacy and dignity issues. Discussion with staff provided evidence of flexible, individual routines in the home. Staff described how they ascertained some people’s choices such as about when they wanted to go to bed. Records noted people’s participation in aspects of daily life in the home, such as helping to make drinks and prepare breakfast. Some mealtimes were observed. People were provided with appropriate support and suitable aids and adaptations were available. Individual dietary needs were seen to be catered for. People were offered choices as far as possible and an alternative was provided when one person indicated that they would rather have something else rather than the dish that had been prepared. Since the last inspection the home has employed a dedicated cook, who works at lunchtimes from Monday to Friday. Staff reported that this had improved the quality of the food and had also freed them up for providing direct care. Meals were seen to be freshly prepared rather than based on processed food. Comprehensive individualised guidance was available describing the support that people needed around eating and drinking. This had been prepared in conjunction with the Community Learning Disability Team. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Appropriate personal and healthcare care support is provided, promoting people’s dignity and wellbeing. Good arrangements are in also place for handling medication, helping to ensure that people stay safe and well. EVIDENCE: The service has policies covering privacy and dignity, including principles and how these are put into practice. Care plans described how people’s individual personal care needs were to be met. During the visits staff were seen offering personal care in a sensitive and discreet manner. The people living in the home were smartly and individually dressed. Staff described how they offered personal care, demonstrating awareness of privacy and dignity issues and of recognising and responding to people’s choices as far as possible. As noted, there was evidence of flexible and individual routines based around individuals’ needs and preferences. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 16 External feedback included, “the care service [is] excellent at respecting clients’ individual needs, privacy and dignity”. Records and discussion provided evidence of people’s routine and specialist healthcare needs being met through appropriate and proactive liaison with professionals and teams in the community. There was evidence of very comprehensive joint working. External feedback provided further evidence for this. There was documentary evidence of best interests work taking place where necessary. Feedback from healthcare workers included that the service was ‘professional and very caring’. Some work had begun around creating health action plans. This included completing hospital assessments to quickly convey significant information to people working at in-patient settings. The team had identified a need to create a more comprehensive summary of recent appointments. Care plans and protocols provided clear guidance about how people’s individual healthcare needs were to be met and how staff needed to respond in emergency situations. In discussion staff demonstrated a thorough knowledge of people’s healthcare needs and conditions. The manager reported that she undertook basic foot care for the people living in the home but that there was access to chiropody services if necessary. There was discussion about the possibility of other staff being trained to undertake foot care tasks. The home has a medication policy dated March 2006. A British National Formulary, other reference books and patient information leaflets were available in the home providing information about medication. Medication administration records were sampled. These were seen to be in order. Some gaps were noted. In one case a code ‘D’ indicating social leave was required. For another medication the manager said that this was often not required, hence gaps in the administration record. It was suggested that if staff make the decision that it is not required then an appropriate code should be inserted with a note made elsewhere as a record of the decision not to administer. The GP could be asked whether it would be better to prescribe such medication on as ‘as required’ basis. Allergy information should be included in the appropriate part of the administration record, even if to record ‘none known’. It was also suggested that copies of PRN (‘as required’) protocols could be included in the administration records file for reference. Other medication records were seen including arrangements for booking medication into the home and returning it to the pharmacy. Documentation Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 17 was available around capacity and consent for medication, and best interests decisions where necessary. Records provided evidence that staff had access to appropriate training around the handling of medication. The AQAA noted plans to retrain all staff around the use of a PEG tube for feeding and medication in order to update people’s knowledge and maintain best practice. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to enable people using the service and their representatives to raise concerns and complaints, helping them to feel listened to. Aspects of complaints’ recording could improve so that there is a clearer audit trail. Measures are taken which help to protect people from harm and abuse. EVIDENCE: Different versions of the complaints procedure were seen, including text and symbol formats. Some recent complaints were discussed with the manager and deputy. There was evidence of satisfactory investigations and resulting actions, although there was scope for improving the documentation process. Some statements had not been signed and dated. In some cases there was no written record of aspects of investigations (neither a statement nor a write-up up of a conversation conducted as part of the investigation). External feedback provided evidence that people with an interest in the home felt able to raise issues and were confident that they would be handled appropriately. Staff described how different people living in the home expressed discontent and dissatisfaction, talking through how they responded. Policies and procedures around adult protection and whistle blowing were seen. These were detailed and made reference to areas such as staff responsibilities Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 19 and the role of other agencies. Copies of important documents such as ‘No Secrets’ and information about the PoVA (Protection of Vulnerable Adults) scheme were available in the home. Arrangements for handling people’s finances were checked. The records and cash totals sampled appeared to be fully in order. The deputy manager said that a new recording system was about to be introduced to make the flow of money in and out of people’s balances clearer. It was agreed that this would be an improvement. Receipts were seen, signed by the staff member who oversaw the transaction. Inventories of people’s significant belongings were being kept. Staff spoken with were clear about their responsibilities around adult protection and had confidence in the arrangements for reporting and dealing with concerns and allegations. Discussion and records provided evidence that people were accessing training about adult protection. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A clean, homely and very well equipped environment is provided for the people living at Apperley House, promoting their comfort and wellbeing. EVIDENCE: All rooms in the home were checked. Bedrooms were personalised and fitted with specialist aids and adaptations. All bedrooms have an en-suite facility. There is also a shared, adapted bathroom as well as additional toilets in the home. During 2007 we were contacted to check whether the home could temporarily convert the dining room into a bedroom for one person who had become unable to manage the stairs to their own room. This was still the case at the time of the visits. Staff, the manager and the Responsible Individual were confident that there were no negative impacts on the people living in the home as they had already been using other shared areas for eating and drinking. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 21 There was a proposal to make a room into an exclusive bathroom for the person living in the former dining room in order to minimise the amount they had to travel to access a bathroom and toilet. The move was still being regarded as temporary as it was hoped that their mobility would recover. In the meantime the room was seen to be spacious and to meet the person’s needs. Communal areas were pleasant and comfortable. It was agreed that the sofas in the lounge would benefit from being replaced, particularly one of them which had shown greater deterioration. The manager confirmed that this had already been requested. The home was found to be fresh and clean throughout. A cleaner had been recruited since the last visit. Some of the staff described infection control arrangements and the protective equipment available. The laundry was checked and found to be in a good state of cleanliness and order. There had been some recent reports of clothing being mixed up or washed incorrectly. Staff reported that this had been highlighted to them and steps taken to address the problem. The ground floor kitchen was spacious, bright and clean. A second smaller kitchen is available on the first floor. There are also lounges on the ground and first floors. A sensory room is provided in the home. This was seen to be well used and staff reported that many of the people living in the home appeared to enjoy spending time there. Some issues were noted, including a flickering light and a broken hinge for one toilet seat cover. These had been put into the maintenance log. The manager and staff reported that such issues were dealt with promptly by a dedicated maintenance person. On the second day of the visits to the home there was power failure. This was very quickly attended to. There was positive feedback about the environment. A family member described the home as ‘welcoming’ and confirmed that it was always fresh and clean in their experience. One healthcare professional wrote that care was provided ‘in a bright and stimulating environment’. Staff spoken with felt that the environment was suitable for meeting people’s needs and confirmed that aids and adaptations were in good working order. Servicing certificates provided further evidence for this. Some new flooring had been fitted in various parts of the home. Staff reported that this was a significant improvement. The home has a garden which was seen to be well maintained. The AQAA noted plans to further develop the garden. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 22 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. 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 have the appropriate knowledge and skills to meet the complex needs of the people living in the home. They are supported by a good training programme. A sound framework for recruitment and selection is in place, helping to safeguard the people living in the home. EVIDENCE: Staff were observed being very attentive to people’s needs and wishes. Care plans were seen to be followed and staff were clearly attuned to people’s nonverbal communication. As noted, staff demonstrated a thorough understanding of people’s needs and conditions in discussion. A considerable amount of information was available in the office about care practices, law, government policy and particular conditions. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 23 As indicated earlier, there was considerable positive feedback about the staff team and the quality of care provided. Comments included that the staff were ‘excellent’ and provided a good standard of care. The AQAA along with discussion with the manager and staff provided evidence that team members were being supported to take appropriate NVQ qualifications in health and social care (National Vocational Qualifications). A handover was observed, with each person being discussed and key information and events being conveyed. Written and verbal feedback from staff indicated that the quality of handovers was good. Recruitment and selection procedures were checked. The manager described the process, including interviewing and the checks that were done before the person started work. A sample of staffing files provided evidence of appropriate procedures being followed, although in one case it was agreed that a reference from a previous social care post which had never arrived should have been chased up in preference to a less relevant one (the organisation’s policy is that a third reference is sought for each applicant in addition to the statutory two). Survey forms completed by staff provided further evidence of necessary checks being done before people started work in the home. Training records were also looked at. Those seen were in need of updating and the manager confirmed that the training coordinator was visiting that week to assist with this. Nonetheless the records provided evidence that people were generally up to date with core training and that they were accessing a range of appropriate specialist courses. Training had included supervisory management, medication training, an in-house epilepsy package, adult protection and infection control. There was no specific training about pressure care but the manager and staff were able to describe how this was managed by appropriate care practices in conjunction with the use of specialist equipment. There were also reported to be very good links with local District Nurses. The manager said that a policy about pressure care was about to be written up. The manager said that training about the Mental Capacity Act 2005 was about to be provided for all staff, although she had already accessed this. In discussion staff expressed satisfaction with the training that they were offered, and described the mandatory and specialist courses which they had accessed. Newer staff described the induction process and said that they were very happy with how they had been introduced to the home and organisation, although there was some feedback about mandatory training needing to be provided more promptly. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 24 Flooding in the summer of 2007 had resulted in the home being cut off (though not directly flooded). The manager and some staff described how the service had come through this difficult period and some of the ongoing impacts that were still being experienced to date. The team was reported to have pulled together exceptionally well. Discussion with the manager and staff along with staffing surveys indicated that the team had been through a period of change and that there had been some short staffing. However, this was reported to have eased as new staff had been recruited. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 25 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. 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 the people living there. Systems are in place which help with monitoring and improving the quality of the service, although some improvements are needed in order to formalise aspects of these arrangements. Health and safety is generally well managed, although some areas could be improved in order to promote people’s wellbeing. EVIDENCE: There was very positive feedback about the manager from staff and other sources. People described her as knowledgeable, hands-on, approachable and open to suggestions. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 26 The manager was trained as a nurse and reported that she maintains her registration. She has also attained the Registered Manager’s Award and completed other relevant training such as about the Mental Capacity Act 2005. A clear management structure was seen to be in place, with a deputy manager and senior staff having clear roles and responsibilities. The deputy manager was undertaking the Registered Manager’s Award. As noted in other sections of the report, many areas of excellent practice were identified through visits to the service and other sources. There was a discussion with the manager and the Responsible Individual about keeping the home manager more ‘in the loop’ at times, i.e. ensuring that key information and decisions were promptly conveyed. The service has a policy about quality management. This includes general principles as well as a structure for how quality is monitored such as through the use of surveys. The manager said that questionnaires for staff were going to be distributed in the next few months. Relatives’ questionnaires had already been sent out. These had been returned to head office and some verbal feedback provided to the team at Apperley House. It was agreed that ideally a written report should be provided to formalise the process more. This could then result in an action plan to help ensure that findings are acted upon. As noted, the manager submitted an Annual Quality Assurance Assessment to us before the inspection. This was thoroughly completed. Other systems were noted as contributing to the process of monitoring and improving quality. These included staff meetings, one to one supervision and a checklist in the office aimed at ensuring that different areas of documentation were up to date for each person living in the home. Reports made under Regulation 26 have not been forwarded to us as required at the last inspection. The most recent report found in the home was for March 2006, although the manager and deputy reported that they were taking place regularly and that there had been a visit about a month previously. Staff spoken with felt that health and safety was well managed in the home and described the various systems in place to promote this. The manager and Responsible Individual reported that there was a contract with a company which provided consultancy around different areas including health and safety. They had already visited the service and begun an audit process. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 27 Records provided evidence of routine health and safety checks taking place, such as for fridge temperatures, and for servicing of equipment and gas appliances. However, tests of fire alarms were not taking place on a weekly basis according to records, although the deputy manager thought that they were probably not all being recorded. These tests should take place at least once a week and be consistently recorded. It was also agreed that a fire drill should take place, the last one having been in September 2007. On the second day of the visits the home experienced some electrical difficulties resulting in loss of power. This was promptly attended to. A copy of the electrical installation certificate was seen. The manager and deputy said that portable appliances had been tested, although the records for these were at head office. Some potentially hazardous chemicals were accessible in an unlocked cupboard. It was agreed that, as a precaution, these should be stored securely. A telephone flex was trailing in a corridor near the office. A request to peg the flex to the wall was added to the maintenance log during the visits. Hot water temperature records were looked at. Some temperatures in December 2007 had been quite high or low (54.2°C for a downstairs toilet and 29.2° for one person’s shower). Records for February 2008 were seen but it was not entirely clear which outlets each of the figures related to. The manager said that she was considering asking the senior staff to assume responsibility for this area to promote consistency. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 28 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 4 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 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 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 4 13 4 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 x 2 x x 2 x Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 YA39 Regulation 26 (5) Timescale for action Supply a copy of monthly reports 31/03/08 made under Regulation 26 to CSCI and to the manager. Timescale of 31/01/07 not met. Requirement 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 4 Refer to Standard YA2 YA6 YA19 YA20 Good Practice Recommendations Consider the potential for the manager to become more directly involved in the assessment process (in relation to people referred to the home) at an earlier stage. Note comments about some aspects of daily records. Continue work to develop Health Action Plans for each person living in the home. See comments in text about inserting appropriate codes to indicate the reason for non-administration such that the chart forms a complete record. Allergy information should be included in the appropriate part of the administration record, even if to record ‘none known’. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 30 5 6 7 8 YA22 YA34 YA35 YA39 9 10 YA42 YA42 Copies of PRN (‘as required’) protocols could be included in the administration records file for reference. Ensure that full records are kept of investigations into concerns and complaints. Consistently chase up particularly relevant references, such as from previous social care employers. All team members should access training about the Mental Capacity Act. Results of surveys conducted as part of monitoring and improving the quality of care should be written up as a report. An action plan should be created as necessary in order to make the process more formal and to ensure that findings are acted upon. Test fire alarms weekly and record each test. Conduct another fire drill. Make the format for recording water temperatures clearer and ensure that there is regular testing. Ensure that any anomalies are checked and outlets adjusted if necessary. Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Apperley House DS0000066470.V354802.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!