Inspection on 17/07/08 for Apple Blossom Court

This inspection was carried out on 17th July 2008.

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

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

Other inspections for this house

Apple Blossom Court 26/09/07

Apple Blossom Court 12/12/06

Apple Blossom Court 08/06/06

Apple Blossom Court 14/03/06

Apple Blossom Court 21/11/05

Apple Blossom Court 15/03/05

Apple Blossom Court 26/07/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Apple Blossom Court 1 Falkland Road Wallasey Wirral CH44 8EN Lead Inspector Daniel Hamilton Unannounced Inspection 17th July 2008 10:30 Apple Blossom Court DS0000018860.V368504.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 Apple Blossom Court DS0000018860.V368504.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. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apple Blossom Court Address 1 Falkland Road Wallasey Wirral CH44 8EN 0151 637 0988 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) No email Apple Blossom Lodge Limited Manager post vacant Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ms Halilogullari is to successfully complete Care/Registered Managers Award by 2005. 26th September 2007 the NVQ Level 4 Date of last inspection Brief Description of the Service: Apple Blossom Court is a small care home that is registered to provide personal care and support for up to 17 adults with a learning disability. The home is a large detached property that has been extended. The property is situated in a residential area of Wallasey, close to local shops, community facilities and bus routes. Bedrooms are located over three floors and are all single rooms. There is a separate dining room, a large communal lounge and an activity room on the ground floor. The home does not have a passenger lift. To the rear of the home there is an enclosed patio/garden area that is accessed through patio doors in the main lounge or through the kitchen door. Care Home Fees range from £425.00 to £850.00 Apple Blossom Court DS0000018860.V368504.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over one day and lasted approximately eight hours. Fifteen people were living in the home at the time of the visit. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The acting manager and support staff were spoken with during the visit and residents were encouraged to participate in the inspection process using their preferred methods of communication. The manager from the sister home (Apple Blossom Lodge) was also present during the final part of the inspection process. Survey forms were also distributed to a number of residents and or their representatives prior to the inspection in order to obtain additional views / feedback about the service. All the core standards were reviewed and previous recommendations from the last inspection in September 2007 were discussed. What the service does well: Apple Blossom Court presented as well maintained and comfortable home. The environment was clean and tidy and residents had personalised their bedrooms with pictures, ornaments and other personal possessions. The people living in the home continued to look after the cleaning of personal bedrooms and the communal parts of the home with support from staff. Staff were observed during the visit and were seen to engage with residents in a positive manner. The people using the service appeared relaxed and comfortable in their home environment and feedback received from residents confirmed they were able to follow their preferred routines and that they were happy living at Apple Blossom Court. Likewise, residents who did not communicate verbally were seen to respond positively to staff interaction by smiling and / or responsive sounds. Examination of records and discussion with residents confirmed residents were encouraged to participate in a range of activities and to maintain relationships with their families and friends. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 6 A three-week rolling menu plan had been developed which offered a choice of meals and a record of individual choices / meals served had been maintained. Feedback received from residents confirmed they were satisfied with the standard of catering. Comments included: “The food is nice” and “I can choose what I want to eat.” Staff working in the home had been correctly recruited and received ongoing training that was relevant to their role. Support workers demonstrated an awareness of the needs of the people they cared for and the principles of good care practice. Information on the personal care needs of residents had been outlined in care plans and records showed that the people living in the home had access to a range of health care professionals, subject to individual need. There had been no complaints since the last visit and policies and procedures were in place to safeguard people from abuse. Residents spoken with during the visit confirmed that they felt safe living in Apple Blossom Court and staff demonstrated a sound awareness of their duty of care to protect vulnerable people and the action to take in response to suspicion or evidence of abuse. What has improved since the last inspection? What they could do better: Key information on the service had been developed in a standard format. The Statement of Purpose / Service User Guide and Complaints Procedure should be produced into an accessible format, to assist people with a learning disability to understand the information more easily. Likewise, the complaints procedure should be updated to include the correct contact details of the Commission for Social Inspection. Some care plans viewed were in need of a review and risk assessments for the use of physical intervention required additional information so that the benefits and risks associated with the use of physical intervention are clearly identified. Furthermore, health action plans should be updated to confirm the health care needs of the people using the service are appropriately planned for. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 7 A basic induction pack had been developed for new employees however the document did not meet all the requirements of the Skills for Care ‘Common Induction Standards’. This should be addressed by the acting manager so that staff are appropriately inducted in accordance with national training standards. The training record should also be updated to provide a summary / overview of the training completed for all staff, in order to improve record keeping. Furthermore, staff should be supported to complete training on Equality and Diversity issues, so that they are aware of the different needs of people accessing social care services. The home did not have a manager in post who was registered with the Commission for Social Care Inspection as noted at the last inspection. The Registered Provider should ensure the acting manager submits an application form to register as the manager as a matter of priority, to ensure the best interests of the people using the service. Information on the outcome of quality assurance surveys should be further developed and made available to service users in a suitable format, to demonstrate that the home is run in the best interests of the people using the service. A copy of the service certificate for the fire alarm system should be obtained to provide evidence that the system has been serviced and the people using the service are safe. Furthermore, risk assessments should be produced for all Safe Working Practice topics to ensure best practice and the temperature at each hot water outlet accessed by the people using the service should be checked and recorded to confirm the temperature is safe and regulated to 43°C. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apple Blossom Court DS0000018860.V368504.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 Apple Blossom Court DS0000018860.V368504.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): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on the service including the Statement of Purpose / Service User Guide should be developed into an accessible format in order to ensure the documentation is appropriate for the needs of the people using the service. EVIDENCE: A Statement of Purpose / Service User guide and Contract had been developed in a standard format to provide information on the service provided. A copy of the documentation was available for reference and had been stored within each resident’s personal file. The acting manager was advised to update the documentation to include the correct contact details of the Commission for Social Care Inspection. A separate brochure on the National Minimum Standards had been developed using pictures, signs and symbols, however a Service User Guide had not been developed in a format that was suitable for the needs of the people using the service. As previously recommended, this matter should be addressed, to assist people with a learning disability to understand the information. Feedback received from the people using the service and / or their representatives via survey forms confirmed they had received information about Apple Blossom Court before they moved in. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 10 A local multi-disciplinary team is responsible for liaising with the Acting Manager about potential admissions. People who are considering moving into the Apple Blossom Court are given the opportunity to undergo a twelve-week trial period. During this time, either party can decide whether the placement is suitable or not. Social Services and the Primary Care Trust regularly review the placements in the home, to ensure the needs of the people using the service are being met. The Annual Quality Assurance Assessment for the service detailed that an admissions procedure was in place, which involved assessing the individual needs of prospective residents. Examination of records and discussion with the Acting Manager confirmed that an assessment of needs was always undertaken prior to people being admitted into Apple Blossom Court. The assessments completed by the service form part of a ‘Proposed Person Centred Care Plan’ and copies were available for reference on files viewed. Copies of assessments completed by other professionals e.g. social workers had also been obtained for some residents. Apple Blossom Court DS0000018860.V368504.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A care planning system has been developed however some plans and risk assessments are in need of review to confirm the needs of the people using the service are monitored and safeguarded. EVIDENCE: The files of three residents were viewed during the visit. Each file contained a ‘Person Centred Care Plan and Risk Assessment’ document that had been developed upon admission. Records showed that Care Plans had been constructed / reviewed in partnership with the people using the service, family members and other relevant professionals (where practicable). Two of the care plans viewed were in need of a 6-monthly review as one was dated 11/09/07 and the other 4/12/07. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 12 Care plans contained information on the personal, social and health care needs of the people using the service and short and long-term goals had been identified. Furthermore, the level of intervention required from staff had been recorded, together with potential risks and hazards. It is recommended that alternative approaches to Person Centred Care Planning be explored as part of the ongoing development of the service. Staff spoken with during the inspection demonstrated a satisfactory understanding of the needs and preferences of the people using the service and confirmed they had read each resident’s ‘Person Centred Care Plan and Risk Assessment’. The people living in the home were encouraged to take appropriate risks associated with the normal aspects of daily life and staff were available at all times to offer support. A policy on the use of physical intervention had been developed for staff to refer to and reference to antecedent behaviour requiring the possible use of physical intervention had been outlined in care plans viewed. The acting manager was advised to refer to Department of Health ‘Guidance for Restrictive Physical Interventions’ in order to ensure that risk assessments for physical intervention are further developed and agreed by Commissioners, in consultation with the people using the service. Advice was also given regarding the development of records used to account for the use of restrictive physical interventions. Staff were observed during the visit and were seen to engage with residents in a positive manner. The people using the service appeared relaxed and comfortable in their home environment and feedback received from residents confirmed they were able to follow their preferred routines and that they were generally happy living at Apple Blossom Court. Likewise, residents who did not communicate verbally were seen to respond positively to staff interaction by smiling and / or responsive sounds. Apple Blossom Court DS0000018860.V368504.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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Meals, activities and routines are flexible and varied to enable the people using the service to have choice and control over their lives. EVIDENCE: The Acting Manager reported that none of the people using the service were in employment, however one person continued to work on a voluntary basis in a luncheon club for older people. One resident was in the process of enrolling with a local college and was due to commence further education training from September. None of the other people living in the home were eligible to attend local colleges as their ‘Passports’ had expired (as they were more than three years old). Five residents continued to attend day services at three different locations. On the day of the inspection only five residents were at home. Two people were away on holidays, four people had accessed the local community to visit places of interest and four residents had been supported to attend a local club. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 14 Each person using the service had a person centred activity programme and an optional list of activities was available for reference. Discussion with the acting manager, staff and residents confirmed the people using the service had the opportunity to participate in leisure, recreational and community based activities. An Activity Sheet and Chart was available in each resident’s file, which detailed that service users had participated in a range of community-based activities e.g. visiting local shops, pubs, parks and places of interest including day trips to the Wirral show, Albert Dock, New Brighton Kite Show and Southport etc. Records of in-house activities had also been recorded. Four residents continued to visit a local church each Sunday and preinspection records detailed that the residents were members of MENCAP and attended their clubs in order to socialise and share their views and ideas. Since the last visit a ‘Resident Holiday and Day trip Summary’ form had been established to record annual holidays. The Acting Manager reported that eight of the people using the service had been supported to have holiday breaks. One of the three records checked detailed that a resident had been supported on a holiday to Butlins in Southport for a period of four days. Feedback received from the people using the service and / or their representatives confirmed service users were assisted to keep in touch with their family and friends. The details of contact had been recorded in files viewed and pre-inspection information received from the manager confirmed that visitors were welcome and that residents were encouraged to invite the people to their home who are important to them. The Annual Quality Assurance Assessment (AQAA) for the service detailed that the people using the service participated in choosing menus, shopping for the home and food preparation and that special dietary needs were catered for. Since the last visit a new cook had commenced employment at Apple Blossom Court and examination of training records confirmed the employee had completed a basic food hygiene course and National Vocational Qualification in Catering at Level 2. The Acting Manager reported that residents had a choice of three meals each day. A three-week rolling menu plan had been developed which offered a choice of meals and a record of individual choices / meals served had been maintained. Feedback received from residents confirmed they were satisfied with the standard of catering. Comments included: “The food is nice” and “I can choose what I want to eat.” Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 15 Meals were served in the dining room and staff were observed to be present to offer support and assistance as required. Residents were able to access a smaller kitchen in order to develop their cooking / daily living skills and to promote independence. The home did not employ any cleaning staff and service users are encouraged to participate in general housework tasks with support from staff. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service receive support with their personal and healthcare needs in order to ensure a healthy lifestyle. EVIDENCE: Discussion with the Acting Manager and staff confirmed that the people living in Apple Blossom Court required different levels of support with personal care. Each resident had a ‘Person Centred Care Plan Review and Risk Assessment Document’, which outlined individual personal and healthcare needs. Records of personal care had also been developed and maintained. The majority of staff spoken with demonstrated a satisfactory awareness of the needs of residents and the principles of good care practice, including the need to be respectful and to promote privacy, dignity, choice and independence when assisting with personal care. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 17 The Annual Quality Assurance Assessment detailed that the people living at Apple Blossom Lodge were supported to visit a GP of their choice and to access other medical practitioners. Summary records of health care appointments were available on each person’s file and these provided evidence that service users had accessed a range of health care professionals subject to individual need. Outcomes of appointments with general practitioners, dentists, chiropodists, opticians and / or audiologists had been recorded on files viewed and each resident’s weight had been monitored on a monthly basis. Two Health Action Plans viewed were not up-to-date and this was discussed with the Acting Manager during the visit. A brief medication policy had been developed for the service. At the time of the visit none of the people living in Apple Blossom Court were self-administering medication and the Acting Manager reported that there were no controlled drugs in the home. The management team reported that staff responsible for the administration of medication had completed both in-house and additional training from the dispensing pharmacist, prior to administering medication. The AQAA also detailed that senior staff had received additional training in the medication procedure in the last twelve months. A member of staff who was administering medication during the visit confirmed this information to be correct. Since the last inspection a record of staff designated with responsibility for administering medication and an identification system for residents had been established. Written statements confirming that staff had been assessed as competent in the handling of medication were also available for reference however no assessments had been produced. Advice was given to the Acting Manager on how to develop a comprehensive competency assessment tool, in order to assess / review the knowledge and competence of staff responsible for administering medication. Medication was dispensed by a local pharmacist using a blister pack system. Medication was stored in a medication cabinet and Medication Administration Records (MAR) viewed had been correctly completed to account for medication received and administered. Apple Blossom Court DS0000018860.V368504.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems have been developed to respond to complaints and to safeguard and protect people from abuse. EVIDENCE: A ‘Comments, Suggestions and Complaints’ policy had been developed in a standard format to provide the people using the service and / or their representatives with information on how to complain. Pre-inspection records detailed that the people using the service were given a copy of the procedure and support to understand the content. The Acting Manager was advised to update the policy to include the new contact details of the Commission for Social Care Inspection and to ensure it was developed in a format suitable for people with a learning disability. The Annual Quality Assurance Assessment (AQAA) for the service detailed that no complaints had been received in the last 12 months and this was confirmed by examining the complaint record for Apple Blossom Court. Likewise, the Commission for Social Care Inspection had not received any complaints regarding the service since the last visit. Pre-inspection records received from the manager confirmed that policies and procedures had been developed to ensure a satisfactory response to suspicion or evidence of abuse. These included an Adult Protection and Prevention of Abuse policy and a Whistle blowing procedure. A copy of the local authority safeguarding adults procedure was also in place for staff to reference. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 19 The Acting Manager on duty reported that all staff had completed training in the Protection of Adults from Abuse. Staff spoken with demonstrated a sound awareness of the different types of abuse, their duty of care to safeguard vulnerable people and internal and external reporting procedures. Residents spoken with during the visit confirmed that they felt safe living at Apple Blossom Lodge and reported that they would speak to family members, senior staff or Maureen (Acting Manager) if they had a problem. The AQAA detailed that there had been two adult protection referrals and investigations since the last visit. Both the referrals concerned the welfare of one service user and were investigated in accordance with the local authority’s Safeguarding Adults Procedure. A recommendation was made following the investigation for service commissioners to review each resident’s needs and the use of physical intervention techniques at Apple Blossom Court. An action plan was also issued to the temporary suspension of placements reported that the requirements of the that the Registered Provider had Provider by Wirral Contracts Team and a was made. The Senior Manager on site action plan had been fully addressed and been authorised to offer placements. Apple Blossom Court DS0000018860.V368504.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is pleasant and maintained to a satisfactory standard. This provides the people using the service with a safe, clean and comfortable environment. EVIDENCE: The service employed a full-time maintenance person who was responsible for gardening and basic maintenance. All other maintenance work was completed by contractors as required. On the day of the inspection the maintenance man was observed to be repainting the walls of a corridor in the home. Previous inspection records confirm that a maintenance and refurbishment plan had not been developed as the home received ongoing investment and maintenance as required. The acting manager confirmed that the owner continued to attend meetings with the management team on a monthly basis, to discuss operational issues and work in need of attention. The Annual Quality Assurance Assessment detailed that new garden furniture had been purchased for the residents to use since the last visit. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 21 Areas viewed during the inspection were maintained to a satisfactory standard and appeared to be free from hazards. The home was clean and tidy and there were no offensive odours. Records received prior to the inspection detailed that the home had allocated housekeeping time and that all staff had completed training in the prevention of infection and management of infection control. Service user’s rooms had been decorated and personalised to their own choice. Please refer to the ‘Brief Description of the Service Section’ for more information on the premises. Apple Blossom Court DS0000018860.V368504.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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service benefit from staff who are appropriately recruited and receive training to undertake their role effectively. EVIDENCE: Apple Blossom Court employed an Acting Manager and a team of 12 care staff to provide direct care and support to the fifteen people using the service. At the time of the visit there was a vacancy for two full-time support workers. Rotas viewed detailed that the home had three support workers and a senior support worker on duty from 7.30 am to 10.00 pm. During the night, the home was staffed with one waking night staff and one staff member provided a sleep-in service. The Annual Quality Assurance Assessment for the service detailed that the Registered Provider had developed a policy on recruitment and employment including redundancy. The Acting Manager reported that two new staff had commenced employment at Apple Blossom Court since the last visit. The files of the two employees were viewed during the visit and each contained the necessary records required under the Care Home Regulations 2001. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 23 A central record of training completed was in place. The record showed that staff had access to Induction, Safe Working Practice and Care specific training opportunities, including the use of physical intervention. It was difficult to assess the level of training completed by staff as information had not been carried forward to provide an up-to-date overview. This issue was brought to the attention of the management team in order that the training records could be improved. Documentary evidence of training completed by the new employees was available on files viewed and highlighted that staff had completed a comprehensive range of training that was relevant to their specific roles. Records showed that the majority of training had been completed in-house using videos produced by a company named ‘BVS’. Records of induction, policies and procedures were available on file however the documentation did not cover all the specification required by Skills for Care Common Induction Standards. Advice was given to the Acting Manager on how to obtain up-todate induction information / training material from the Skills for Care website as similar issues were noted at the last inspection. The Annual Quality Assurance Assessment completed by the Senior Manager detailed that 7 (58.33 ) of the staff team had achieved a National Vocational Qualification (NVQ) level 3 in Care. On the day of the visit, documentary evidence of National Vocational Qualifications could be located for only four staff (33.33 ). The acting manager reported that a further two staff (16.66 ) had completed the award and were due to receive certificates and a further three staff (24.99 ) had registered to commence a National Vocational Qualification. Staff spoken with confirmed they had access to induction, ongoing training opportunities and one to one supervision. Records were kept of each session. Staff spoken with demonstrated a satisfactory understanding of the principles of care but lacked knowledge and understanding of equality and diversity issues. This training need was discussed with the acting manager and should be explored further in order to improve awareness of this important subject. Apple Blossom Court DS0000018860.V368504.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a manager who is registered with the Commission and some aspects of the administration are in need of review and development to ensure the service is run in the best interests of the people using the service. EVIDENCE: The home does not have a manager who is registered with the Commission for Social Care Inspection. An Acting Manager remains in day-to-day charge of the home and is being supported by the Senior Manager from the sister home (Apple Blossom Lodge). The Acting Manager reported that she had decided to apply for registration with the Commission for Social Care Inspection and that she would arrange to submit an application in consultation with the owner. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 25 The Company did not employ an external consultant to undertake a quality assurance assessment. The acting manager reported that questionnaires were sent out to residents and / or their representatives annually and that they had been distributed during March 2008. The questionnaires had been developed in a format that was geared towards the needs of people with a learning disability. A summary of findings had been produced which highlighted that the overall judgement appeared to be that the comments were positive. The acting manager was recommended to develop the system further and to ensure that the results of service user surveys were published and made available to the people using the service, their representatives and other interested parties. Records detailed that the home had a health and safety policy for staff to reference and information contained in the Annual Quality Assurance Assessment for the service provided evidence that equipment and / or services within the home had been serviced or tested. Examination of fire records confirmed the fire alarm system, emergency lights and extinguishers were tested or visually checked on a weekly basis. A fire risk assessment had been completed however this was not dated and there were no risk assessments in place to address all the Safe Working Practice topics. This issue was also noted at the previous inspection. The acting manager reported that the hot water outlets were regulated from the boiler however records were not in place to confirm the temperature at each outlet was being monitored on a regular basis. Apple Blossom Court DS0000018860.V368504.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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 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 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 3 X 2 X 2 X X 2 X Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The Statement of Purpose and Service User Guide should be developed into an accessible format, to assist people with a learning disability to understand the information. Care Plans should be reviewed at least every six months and alternative approaches to person centred planning should be explored. This will help to confirm that the needs of the people using the service are closely monitored. Risk assessments for the use of physical intervention should be further developed in accordance with guidance issued by the Department of Health and agreed with Commissioners, so that the benefits and risks associated with the application of intervention techniques is clearly identified. Health Action Plans should be updated in order to verify that the Health Care needs of the people using the service are appropriately planned for. 3. YA9 4. YA19 Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 28 5. YA22 6. YA35 7. 8. 9. YA35 YA35 YA37 10. YA39 11. 12. YA42 YA42 13. YA42 The Complaints procedure should be updated to include the correct contact details of the Commission for Social Inspection and produced in a format suitable for people with a learning disability. The Acting Manager should ensure that the induction programme is updated so that staff receive induction training that is fully compliant with the Skills for Care ‘Common Induction Standards’. Staff should be supported to complete training on Equality and Diversity issues, so that they are aware of the different needs of people accessing social care services. The training record should be updated to provide a summary / overview of the training completed for all staff on one page in order to improve record keeping. The Registered Provider should recruit a manager and / or ensure a completed application form to register a manager is forwarded to the Commission for Social Care Inspection as a matter of priority, to ensure the best interests of the people using the service. Information on the outcome of quality assurance surveys should be further developed and made available to service users in a suitable format, to demonstrate that the home is run in the best interests of the people using the service. Risk Assessments should be produced for all Safe Working Practice topics to ensure best practice. A copy of the service certificate for the fire alarm system should be obtained to provide evidence that the system has been serviced and the people using the service are safe. The temperature at each hot water outlet accessed by the people using the service should be checked and recorded to confirm the temperature is safe and regulated to 43°C. Apple Blossom Court DS0000018860.V368504.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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