Inspection on 01/10/08 for Apple Blossom Lodge

This inspection was carried out on 1st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple Blossom Lodge 01/06/06

Apple Blossom Lodge 17/02/06

Apple Blossom Lodge 07/11/05

Apple Blossom Lodge 16/03/05

Apple Blossom Lodge 15/09/04

Apple Blossom Lodge 11/03/04

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Apple Blossom Lodge 8 St James Road Wallasey Wirral CH45 9LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Daniel Hamilton     Date: 0 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Apple Blossom Lodge 8 St James Road Wallasey Wirral CH45 9LS 01516391218 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Apple Blossom Lodge Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 14 Date of last inspection Brief description of the care home Apple Blossom Lodge is a large detached three-storey house set in a residential area in Wallasey Wirral. It is close to New Brighton amenities including shops, cafes, pubs, train station, sporting facilities and the promenade. To the front of the home there is a small railed garden area leading to the front door and there is a larger garden area situated to the rear. There is some on road parking available to the front of the home. Residents? bedrooms are all single rooms with a number of communal lounges being available on the ground and basement area. The main dining room is situated in the basement area. 14 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 8 hours. A partial tour of the premises took place and observations were made. Three care files were examined and a selection of staff and service records were also viewed. The manager and support staff were spoken with during the visit and service users were encouraged to participate in the inspection process using their preferred methods of communication. An expert-by-experience also assisted in the inspection process. An expert-byCare Homes for Adults (18-65 years) Page 5 of 30 experience is someone who, because of their shared experience of using care services or ways of communicating visits a service with an inspector, to help get a picture of what it is like to live in or use the service. Survey forms were distributed to a number of residents or their representatives prior to the inspection in order to obtain additional views and feedback about the service. All the core standards were reviewed and previous recommendations from the last inspection in June 2006 were reviewed. The Care Home Fees for this service were 360.65 to 889.81 pounds per week at the time of the visit. What the care home does well: What has improved since the last inspection? What they could do better: The Service User Guide should be developed into an accessible format, to enable people with a learning disability to understand the information more easily. Alternative approaches to Person Centred Planning should be explored, to ensure the ongoing development of the care planning system. A record of deserts should be recorded, to provide information on the dietary intake for each service user. Care Homes for Adults (18-65 years) Page 7 of 30 The dampness in the quiet room must be rectified, to ensure the odour is removed and the environment is homely, comfortable and safe for the people using the service. Furthermore, the bedroom with the stained carpet should be cleaned or replaced, to ensure the area is kept clean and hygienic. The induction programme should be updated so that staff receive induction training within the first 12 weeks of their employment that is fully compliant with the Skills for Care Common Induction Standards. The temperature at each hot water outlet accessed by the people using the service should be regularly checked and recorded, to confirm the temperature is safe and regulated to 43 degrees centigrade. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service User Guide should be developed into an accessible format, to enable people with a learning disability to understand the information on the service more easily. Evidence: A Statement of Purpose, Service User guide and Contract had been developed in a standard format to provide information on the service provided at Apple Blossom Lodge. A copy of the documentation had been stored in each residents personal file and additional copies were available in the office upon request. 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. The manager was recommended to address this matter, to assist people with a learning disability to understand the information more easily. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: Feedback received from the people using the service or their representatives via survey forms confirmed they received information about Apple Blossom Lodge prior to admission. The Annual Quality Assurance Assessment for Apple Blossom Lodge detailed that policies and procedures were in place for referral and admission and that prior to admission the needs of prospective service users were assessed in consultation with family members and other professionals. People who are considering moving into the Apple Blossom Lodge 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 and evidence of a recent review from a placing authority was available for reference. Three service user files were viewed during the visit and each confirmed that the needs of the people using the service had been assessed before moving into Apple Blossom Lodge. The assessments completed by the service form part of a Proposed Person Centred Care Plan. Copies of assessments completed by other professionals e.g. social workers and health care professionals had also been obtained. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessed and changing needs of the people using the service are taken into consideration in the planning of the service, to promote and safeguard independence and wellbeing. Evidence: A sample of three service users files were viewed during the visit. Each file contained a Person Centred Care Plan and Risk Assessment document. Care Plans contained information on the personal, social and health care needs of the people using the service, the level of support required from staff and individual goals. Care plans had been regularly reviewed and individual risks and hazards had been identified. The manager was recommended to explore alternative approaches to Person Centred Care Planning 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 Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: read each service users care plan. The people living in the home were supported to take responsible risks associated with the normal aspects of daily life and information, guidance and risk assessments had been developed to ensure staff were clear about the circumstances and risks associated with the use of restrictive physical interventions. Advice was given regarding the development of the homes policy on physical intervention. Staff were seen to engage with residents in a friendly and caring manner during the visit. The people using the service appeared relaxed and comfortable in their home environment. Service users reported that they were able to follow their preferred daily routines and activities and some people were observed to be discussing their choice of evening meal during the inspection. Feedback received from service users confirmed they were satisfied with the lifestyle at Apple Blossom Court. For example, one service user reported; I like it here, it is the best. Likewise, another service user said; Everyone likes living here. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals, activities and routines are flexible and varied. This enables the people using the service to have choice and control over their lives. Evidence: At the time of the visit, none of the people using the service were in employment or attending day centres as individual passports had expired. A person-centred activity plan had been developed for each service user, which indicated that the people living in the home had access to a variety of community based activities. An optional range of activities had also been developed. On the day of the visit, two service users had gone out shopping and for lunch in the local community and two people had been supported to attend health care Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: appointments. The remaining service users were observed to be relaxing in the communal areas of the home or participating in recreational activities. Discussion with the people using the service and examination of holiday and day trip summary records confirmed service users were supported to access the community regularly. For example, records viewed detailed that some service users had visited local shops, Wirral show, pictures, blue planet aquarium etc. Service users were also observed to talk about visiting the pub, restaurants, bowling, swimming and the seaside. A number of residents had also been supported to have an annual holiday during the year and the manager reported that eight service users were supported to attend local churches in the area. Residents spoken with confirmed they had enjoyed their holidays and one person reported I had a nice time. Feedback received from the people using the service or their representatives confirmed service users were assisted to keep in touch with their family and friends. The details of contact had been recorded on personal visit summary sheets and pre-inspection information received from the manager confirmed that visitors were welcome and that residents were encouraged to invite people to their home who are important to them. The Wirral Advocacy service was also involved with the service. 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 with support from general practitioners and dietitians as required. The AQAA also highlighted that service users were encouraged to eat out or order a take away of their choice. A three-week rolling menu plan had been developed which offered a choice of meals and a varied and nutritious diet. The meals record book did not always record deserts and some entries were missing. Examples were discussed with the manager during the visit. Meals were prepared by the people using the service with support from staff and served in the dining room, which was located in the basement. Tables were equipped with napkins, table mats and tablecloths. The people using the service reported that they helped with meal preparation and chose what they wanted to eat each day. Staff were also observed to ask people what they wanted for lunch on the day of the visit. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Service users spoken with enjoyed talking about the meals and reported the food was good. One person reported; I like the food. Im having curry and rice tonight. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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: The people living at Apple Blossom Lodge required different levels of support with personal care. Care plans viewed contained information on the personal and healthcare needs of the people using the service and records of personal care had been maintained. The Annual Quality Assurance Assessment (AQAA) for the service detailed that staff were trained to be mindful of each service users right to privacy, dignity, independence and control over their life. Staff spoken with during the visit demonstrated knowledge and understanding of the principles of good care practice and were observed to be respectful to the people living in the home during the visit. Records showed that service users were registered with local general practitioners and some people received input from the specialist learning disability services at Ashton Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: House. Summary records of health care appointments were available on each persons file and these provided evidence that service users had accessed a range of health care professionals subject to individual need. Evidence of appointments with general practitioners, hospital staff, dentists, psychiatrists, chiropodists and opticians had been recorded on files viewed and each residents weight had been monitored on a regular basis. A medication policy and procedure had been developed for the service. The manager reported that none of the people living in Apple Blossom Lodge were self administering medication and there were no controlled drugs in the home at the time of the visit. A record of staff responsible for the administration of medication was in place and staff responsible for the administration of medication had completed both in-house and additional training from the dispensing pharmacist, prior to administering medication. The manager reported that she had also undertaken an assessment of competency, to verify that staff understood how to correctly apply the medication procedures in practice. Medication was dispensed by a local pharmacist using a blister pack system. Medication was securely stored in a medication cabinet and Medication Administration Records (MAR) viewed had been correctly completed to account for medication received and administered. The manager was advised to monitor and record the temperature of the room used to store medication. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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 to provide the people using the service and their representatives with information on how to provide feedback or complain about the service at Apple Blossom Lodge. The Annual Quality Assurance Assessment for the service detailed that the people using the service were given a copy of the procedure and support to understand the content. The policy had also been produced in an alternative format, with the input of service users, to assist people with a learning disability to understand the information. The Annual Quality Assurance Assessment (AQAA) for Apple Blossom Lodge detailed that one complaint had been received in the last 12 months and this was confirmed by examining the complaint record for the service. The complaint was made by members of the public and concerned an incident in the community. Records showed that the incident was investigated by the manager. The Commission for Social Care Inspection had also received one anonymous compliant which was referred to the Provider. The complaint concerned the arrangements for providing personal care to service users and for administering Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: medication. This complaint was investigated by the manager and appropriate action was taken to improve practice. The AQAA 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. The Manager reported that all staff had completed training in the Protection of Adults from Abuse with Wirral Borough Council and training records confirmed the same. Senior staff had also completed Safeguarding Adults process training. The AQAA detailed that there had been three adult protection investigations since the last visit. The first referral concerned the welfare of a service user upon admission to hospital, the second concerned a service user having contact with a family member and the third concerned an incident in the local community. The concerns regarding the first two referrals could not be substantiated and the latter incident was not investigated in accordance with the local authoritys Safeguarding Adults Procedure, as the manager had conducted her own investigation. Advice was given on the action taken by the manager, to ensure future incidents are investigated as part of a safeguarding referral. Staff spoken with during the inspection confirmed they had completed training in the Protection of Vulnerable Adults and were able to demonstrate knowledge and understanding of the different types of abuse, reporting procedures and their duty of care to safeguard vulnerable people from abuse. Service users spoken with during the visit confirmed they were generally happy living in the home however some people expressed concern regarding the behaviour of some of the other service users they lived with. This information was discussed with the manager of the service and examination of care plans confirmed that, at times, some people living in the home can become anxious or agitated. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the home are in need of maintenance, to ensure the people living in the home benefit from a homely, comfortable and safe 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. The manager reported that Apple Blossom Lodge received ongoing investment and maintenance as required and records of maintenance were available. Job sheets were also maintained for work in need of attention. Concern was noted regarding the cleanliness of a service users bedroom carpet and the smell and evidence of dampness in the quiet room. Other areas viewed during the inspection were generally clean and tidy and had been maintained to a satisfactory standard. Communal lounges were furnished with comfortable furniture and television and music facilities were available. One service user reported that they liked listening to Elvis Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Presley and put an Elvis CD on during the inspection. Service users rooms viewed 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. Records received prior to the inspection detailed that the home had allocated housekeeping time and that all staff had completed training on infection control. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been established to ensure staff are appropriately recruited and trained for their roles. This ensure the people using the service are protected and in safe hands. Evidence: Apple Blossom Lodge employed a Manager and a team of 12 care staff to provide direct care and support to the people using the service. On the day of the visit, 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 a robust recruitment policy had been developed to protect the welfare of the people using the service. The manager reported that four new staff had commenced employment at Apple Blossom Lodge since the last visit and the files of the employees were viewed during the visit. Each file contained the necessary records required under the Care Home Regulations 2001 and training records showed that staff had access to a range of training that was relevant to their role and responsibilities. Examples of training Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: completed by staff included; safe working practice, physical intervention, medication, managing challenging behaviour, abuse, raising concerns and whistleblowing and the principles of person centred care etc. Documentary evidence of training completed by the new employees was also available for reference. Records of induction were available on file however the documentation did not cover all the specification required by Skills for Care Common Induction Standards. The Manager was advised to obtain up to date induction information and training material from the Skills for Care website. The Annual Quality Assurance Assessment completed by the Senior Manager detailed that 4 (33.33 ) of the staff team had achieved a National Vocational Qualification NVQ level 2 or above in Care. On the day of the visit, documentary evidence of National Vocational Qualifications could be located for only three staff (24.99 ). The manager reported that a further six staff (49.99 ) had registered to commence a National Vocational Qualification and four staff had left employment since the last inspection with a National Vocational Qualification in Care at level 3. Staff spoken with demonstrated a good understanding of the diverse needs of the people using the service and confirmed that they had access to ongoing training training opportunities and formal supervision. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems have been developed, to ensure the service operates efficiently and in the best interests of the people living in the home. Evidence: Apple Blossom Lodge is managed by Mrs Doris Cave who is registered with the Commission for Social Care Inspection. The Manager reported that she had managed the service since September 1997 and records detailed that the manager had over 18 years experience in working with adults with a learning disability. Examination of training records and certificates confirmed the manager had completed safe working practice training and other training relevant to her role. This included abuse, managing challenging behaviour, effective communication, principles of person centred care, employment law, employment legislation, dementia care for managers and supervision in the home etc. At the time of the visit the manager had not completed a National Vocational Qualification level 4 in Management or Care. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Feedback received from the people using the service, staff and relatives confirmed the manager was approachable and supportive. For example, a service user reported, I like living here. Doris [Manager] is good and another person said I love it here. Doris [Manager] has done a great job. The Company did not employ an external consultant to undertake a quality assurance assessment. An internal quality assurance system had been established which involved sending questionnaires to the people using the service or their representatives. This process was last completed during February 2008. The questionnaires had been developed in a format that was geared towards the needs of people with a learning disability and a summary of findings had been produced. Advice was given regarding the use of the survey findings, to develop an annual development plan for the home. Records were available to also confirm that the responsible individual had visited the home on a monthly basis to review the standard of care provided and that team and service user meetings had been coordinated periodically. The Annual Quality Assurance Assessment (AQAA) detailed that Health and Safety policies and procedures were in place and that test and maintenance checks were undertaken periodically. Fire records were viewed during the visit. Overall, weekly tests of the fire alarm system had been completed however some gaps were noted. Evidence of regular checks of the emergency lighting and visual checks of the fire extinguishers had been recorded and service certificates for the fire alarm system and fire extinguishers were available for reference. A fire risk assessment had been completed and a food hygiene risk assessment was available for reference. The manager was recommended to monitor and record the temperature of hot water outlets in all rooms and areas accessed by the people using the service. Furthermore, the manager was advised to establish a health and safety check list audit for the environment. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The dampness in the quiet room must be repaired. This will ensure the environment is homely, comfortable and safe for the people using the service. 01/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should be developed into an accessible format, to assist people with a learning disability to understand the information. Alternative approaches to Person Centred Planning should be explored. This will help to ensure the ongoing development of the care planning system. A record of deserts should be recorded, to provide information on the dietary intake for each service user. The temperature of the room used to store medication should be monitored and recorded, to ensure the temperature does not exceed 25 degrees centigrade. The stained bedroom carpet should be cleaned or replaced, to ensure the area is kept clean and hygienic. The induction programme should be updated so that staff 2 6 3 4 17 20 5 6 30 35 Care Homes for Adults (18-65 years) Page 28 of 30 receive induction training that is fully compliant with the Skills for Care Common Induction Standards. 7 37 The manager should complete a National Vocational Qualification in Management and Care at level 4, to ensure she has the necessary qualifications for her role. 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 degrees centigrade. 8 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. 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