Inspection on 07/11/05 for Apple Blossom Lodge

This inspection was carried out on 7th November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple Blossom Lodge 01/10/08

Apple Blossom Lodge 01/06/06

Apple Blossom Lodge 17/02/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Apple Blossom Lodge 8 St James Road Wallasey Wirral CH45 9LS Lead Inspector Helen Carton Unannounced Inspection 7th November 2005 09:45 Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 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 Lodge DS0000018861.V265149.R01.S.doc Version 5.0 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 Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Apple Blossom Lodge Address 8 St James Road Wallasey Wirral CH45 9LS 0151 639 1218 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) Apple Blossom Lodge Limited Mrs Doris Cave Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person over 65 years old can be accommodated Date of last inspection 16th March 2005 Brief Description of the Service: 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. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 14 residents’, living at Apple Blossom Lodge at the time of the visit. The inspection was unannounced and took approximately six hours over two days. Two inspectors’ visited the home and spent time with most of the residents’. The inspectors also spoke to the manager and members of the staff team. What the service does well: What has improved since the last inspection? What they could do better: Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 6 The home needs to look at how it involves residents’ in decision making both about themselves and how the home is run. They need to make sure this information is recorded and that this demonstrates, so far is practicable, how residents are involved in decisions about the care they are to receive as well as decisions about their health and welfare. The home needs to review their risk assessments so they give more detail about the risks for individual residents and how staff are to best support residents at times when their behaviours challenge staff. It is especially important to be clear about what type of physical support/restraint should be used, if necessary, so that residents can be adequately safeguarded. The home must also look at ways to make sure other people involved in supporting residents’, especially relatives and placing social workers, are fully aware of how care is to be provided and in what ways the home is to support and supervises residents’. The home has arranged training for the staff team about protecting vulnerable adults from all forms of abuse. Following this training the home must look at the routines currently in place at the home and evaluate them to make sure they are there still necessary and indeed relevant to meeting the needs of the residents’. 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. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&5 The home’s Statement of Purpose and Service User Guide provides good information for residents, prospective residents and their representatives about the home. However more detailed information is required with regard describing the ethos and care practices employed within the home. EVIDENCE: The home has produced a detailed statement of purpose and service user guide. This help’s prospective residents’, their relatives and representatives to decide if Apple Blossom Lodge is the right home for them. The inspector would advise the manager and owners’ to review these documents in order To provide greater detail about the client group they support and how they go about doing this. This should provide very clear information to all parties about the approach used in working with the residents. Residents’ contracts provide detailed information. However the inspector would advise the manager and owners to include a copy of the resident’s care plan and risk assessments so that the resident, their representatives and the placing authority are fully aware of the specific care and support to be provided. This is especially important should there be any potential restrictions on choice, freedom, service or facilities. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 The care planning system in place is satisfactory and provides the staff team with the information they need to adequately meet residents’ needs. However the home is unable to clearly demonstrate that they actively seek the views of residents’ in decision making about their personal lives and how the home is run. EVIDENCE: The home has detailed care plans, which provide the staff team with sufficient information and guidance as to the most appropriate care and support to be provided to residents. However the risk assessments and management plans are not as detailed and do not provide enough detailed information about the type and level of restraint that may need to be used to keep individual residents safe. During the visit the manager provided the inspectors’ with information about the restraint training the whole staff team had undertaken. A British Institute of Learning Disabilities (BILD) accredited trainer delivered this training. The inspectors’ asked members of the staff team to demonstrate the techniques they had been taught and they appeared to be safe and used minimal force to Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 10 restrain. All members of the staff team told the inspectors they would only use restraint if all other methods of support had failed such as diverting techniques. The inspectors’ discussed with the manager the need for the home to show they have actively sought the involvement of residents’, their families, and other professionals and representatives of the placing authority in devising behaviour management plans when decisions are being made that restrict residents’ freedom of choice and independence in the community. The manager told the inspectors’ she invites all parties to formal reviews, which are attended by a small number of professionals. The inspectors’ advised the manager to send copies of the reviewed care plan and risk assessments to all professionals responsible for supporting and monitoring the placement and invite their comments. By doing this, the home is showing they are being open, honest and seeking others views about the care, support and supervision being provided by the home. The inspectors’ discussed with the manager the need to support residents’ to set up a group to enable them to take an effect role in decision making in the home. Since visiting the home the manager has told the inspectors’ she had contacted MENCAP for advice and support on the best way to set up a residents group. They told her they would be happy to facilitate these meetings until the group becomes established. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13,14 & 16 Links with the community are good and provide residents’ with social opportunities to engage and participate in the local community. There is a lack of educational activities available for residents’ to access. Consultation with residents is limited with little documentary evidence that their views are sought and acted upon. The manager and staff team have a sound understanding of residents’ support needs, and there were clearly some positive relationships between staff and residents. EVIDENCE: The home offers residents’ the opportunity to take part in a range of community activities at a local leisure centre. During the visit the inspectors’ observed residents’ going out in the community with staff support. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 12 Residents are able to attend a range of evening clubs run by members of MENCAP. A number of the residents’ also attend soft play sessions for sensory stimulation and enjoyment. Residents’ are able to attend numeracy and literacy sessions at the other home owned by the owners’ twice a week. The manager told the inspectors’ residents’ will access community events as and when they happen. The inspectors’ advised the manager to make sure residents’ risk assessments accurately reflect all risk factors that may occur while residents are out in the community. Also those members of the staff supporting residents’ out in the community should have access to a mobile phone to call for assistance if needed. One of the two inspectors’ who visited the home spent time with the residents’ who appeared at ease in the home and looked to the staff team for positive reinforcement. Residents’ said they enjoyed going out of the home with members’ of the staff team. The inspectors’ advised the manager to make sure residents’ involvement in decision making about the activities they are involved in are recorded. The inspectors’ discussed with the manager the lack of educational opportunities for residents’. The manager told the inspectors’ the residents had received the Wirral three-year passport allowing them free access to specialist educational courses. However they have now run out and cannot be renewed. During the inspection a relative of a resident took the time to talk to an inspector. They told the inspector they were very happy with the care and support offered to their relative. They said they were grateful to the manager for her dedication and support to their relative. Which has resulted in an improvement in their behaviour making it possible to take them out unaccompanied to shops and cafes. They felt this had been the most important and positive change in their relationship for many years. The manager informed the inspector two residents’ went on a four-day break last spring. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure residents’ medication needs are being met. EVIDENCE: One of the inspectors’ checked a sample of residents’ medication and looked at the home’s medication policy and procedure. The medication was well maintained and all necessary information is recorded. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The staff team have a basic understanding of Adult Protection issues however lacked insight into the use of the type of locks fitted to bedroom doors. The home has a satisfactory complaints system with some evidence that residents’ concerns are listened to and acted upon. EVIDENCE: The manager has carried out a piece of work to produce the Younger Adults National Minimum Standards in a user-friendly format for residents’. She has also produced a complaints procedure in a similar format and intends to add photographs of the management team and owners’ to enable residents to know who to talk to if they are worried about anything. While the inspectors’ were looking at a number of bedrooms they noticed locks were fitted about a third of the way up some of the doors. This type of lock is a security lock with the person in charge of the home having the key. The inspectors’ told the manager this type of lock is unacceptable as bedroom doors can be locked from the outside. This could result in residents’ being locked in their rooms against their will. The manager was shocked at these comments and informed the inspectors’ some residents’ had requested locks and this type had been recommended. She informed the inspectors’ they would be removed that day. A follow up visit confirmed the locks had been removed. The manager informed the inspectors’ she has booked specialist training dealing with the protection of vulnerable adults and indicators of abuse. This training is to take place on the 29th and 30th November 05 and will include the Wirral Social Services protection of vulnerable adults protocols. The whole staff team including the owners are attending this training. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 15 Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 & 30 Recent investment has significantly improved the appearance of this home creating a comfortable environment for those living there and visiting. EVIDENCE: Over the past eighteen months the owners have made many improvements to the exterior of the home including new windows, painting, repair of the roof and the erecting of new wrought iron fencing and gates. All areas of the home viewed during this visit were clean and tidy. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 & 36 The staff morale is high with them demonstrating a clear understanding of their roles. The owners, manager and staff team demonstrate a commitment to continuing professional development through the training being undertaken. However since the last inspection visit the standard of vetting and recruitment practices has declined with appropriate checks not being carried out that potentially leave residents at risk. EVIDENCE: Since the last inspection visit all members of the staff team have started NVQ level 3 training with specialist units in supporting adults with a learning disability being included. Members of the staff team told the inspectors’ they were well supported by the manager and senior support workers and were very clear on what their roles are within the home. They told the inspectors’ at the beginning of each shift they are given information about each resident so they know how to approach and support residents’. Two members of the staff team gave the inspectors permission to look at their supervision records, which showed the manager discusses all the main areas of their work including training needs. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 18 A selection of staff files were looked at. The manager was advised to make sure all the necessary checks including current Enhanced Criminal Records checks are carried out prior to employment. The manager told the inspectors’ the Criminal Records Bureau (CRB) had informed her that checks were transferable between jobs. The inspectors’ would advise manager that since the implementation of the POVA scheme this has restricted CRB portability in relation to regulated services for adults. The Care Standards Act requires that new staff are checked against the list prior to being offered employment. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 The manager is supported by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager has worked at the home for approximately eight years and has over 16 years experience of working with adults with learning disabilities. Issues about the detail in some of the records held by the home such as the care plans and risk assessments are documented in this report. The inspectors’ acknowledge on the whole the standard of record keeping in the home is good. The inspectors’ discussed with the manager the need to demonstrate and document work carried out with residents’ that shows their involvement in decision making about their lifestyles and living at the home. The manager reacted positively to this discussion and has involved members of MENCAP to be part of this process. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 20 Issues of health and safety such as the use of inappropriate locks on bedroom doors and the need for more detailed risk assessment were discussed with the manager. The manager reacted positively to these discussions and removed the locks and is reviewing the risk assessments. Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 2 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 2 X X X 3 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score 3 2 X 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Apple Blossom Lodge Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000018861.V265149.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 4 Requirement The registered persons must ensure the Statement of Purpose provides detailed information regarding the range and complexity of needs they can provide for. The registered persons must ensure where a local authority has made arrangements for the provision of accommodation or personal care at the home that they are provided with a copy of the agreement specifying all the arrangements made including risk assessments, management plans and a detailed care plan. Timescale for action 30/01/06 2 YA5 5 30/01/06 Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 23 3 YA7YA39YA8YA16 12 The registered persons must ensure residents’ views are actively sought with regard to their individual lives and in the running of the home. These interactions and discussions must be recorded. The registered persons must ensure residents’ risk assessments and management plans provide detailed information regarding action to be taken to diffuse difficult situations and if necessary the restraint techniques to be used as a last resort. 30/01/06 4 YA9 13 30/01/06 5 YA11YA12 16 The registered 20/02/06 persons must ensure a review of activities offered to residents’ is undertaken to ensure educational opportunities external to the home are explored. The registered persons must ensure all issues of possibly abusive practice are fully discussed with the staff team with particular regard to the locks, which were fitted to some bedroom doors. The registered 30/01/06 6 YA23YA26YA32YA35YA42 13 7 YA34 19 07/11/05 Page 24 Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 persons must ensure all the recruitment processes are carried out with particular regard to obtaining CRB and POVA first checks prior to commencement of employment. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Apple Blossom Lodge DS0000018861.V265149.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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