Inspection on 10/08/06 for Apple House

This inspection was carried out on 10th August 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple House 31/07/08

Apple House 16/07/07

Apple House 22/02/06

Apple House 16/12/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Apple House 186 Seafield Road Bournemouth Dorset BH6 5LJ Lead Inspector Heidi Banks Key Unannounced Inspection 10th August 2006 12:10h Apple House DS0000063160.V309179.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 House DS0000063160.V309179.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 House DS0000063160.V309179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apple House Address 186 Seafield Road Bournemouth Dorset BH6 5LJ 01202 429093 01202 773410 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 House Limited Mrs Jane Elizabeth Montrose Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to be admitted must be ambulant and able to manage stairs. 22nd February 2006 Date of last inspection Brief Description of the Service: Apple House is a residential care home registered to accommodate a maximum of four adults with a learning disability. It is one of two homes owned by Apple House Limited in the Bournemouth area. Apple House is a semi-detached house located in the Southbourne area of Bournemouth. The property is in keeping with the neighbourhood. It is situated within easy reach of local shops and community facilities. The home has a vehicle which can accommodate all service users. There is on-road parking at the front of the house. Bus routes to the nearby towns of Christchurch, Boscombe and Bournemouth are easily accessed. Accommodation is provided in single bedrooms. Three bedrooms are on the first floor of the property, one of which has its own en-suite facilities. There is one bathroom for shared use by three residents. One bedroom is situated on the ground floor. The home has an attractively decorated and furnished lounge, kitchen and dining room area. There is a patio area and garden to the rear of the property for use by residents. Fees for individual service users at Apple House are variable depending on their level of need and currently range from £613 to £875 per week. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection of Apple House which took place over 7.5 hours on two weekdays. There are four permanent residents living at Apple House at the present time. During the course of the inspection the inspector was able to meet three of the four service users and a senior member of the care staff team. The inspector was also assisted by the Registered Manager of the home, Jane Montrose, and the Responsible Individual, Romaine Lawson. The inspector was also given a guided tour of the home by one of the service users. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. One completed service user survey was received in addition to a comment card from a general medical practitioner and a comment card from a social care professional. A pre-inspection questionnaire completed by the Registered Manager was also supplied. Information obtained from these sources is reflected throughout the report. Twenty-three standards were assessed during this inspection. What the service does well: Service users’ needs and wishes are assessed prior to them moving to Apple House and there is evidence that the home liaises with placing authorities to ensure that their requirements can be met by the service. The home achieves positive lifestyle outcomes for service users by working with them in a way that supports them in meeting their personal goals and promotes their rights. Support offered is individualised according to service user’s needs and service users spoken to indicated that they felt able to make choices about what they do on a daily basis and be involved in decisionmaking. There was ample evidence to demonstrate that the home works hard to meet the personal care, physical and emotional health needs of service users. Service users spoken to reported that they feel staff respect their privacy, dignity and independence. Service users are supported to access a range of primary health care services and there was evidence on record that the home works in partnership with specialist services to meet the specific needs of service users. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 6 The home provides a clean and comfortable environment in which to live and it is clear that maintenance is carried out and equipment is updated to ensure it meets the needs of service users. A clear management structure is in place and systems are in place to promote good communication among the staff team. What has improved since the last inspection? What they could do better: As a result of this inspection, seven requirements and nine recommendations have been made. Two requirements have been repeated from the last inspection of the service where issues have been partially, but not fully, addressed by the provider within the set timescale. Record-keeping in relation to the meals eaten by individual service users must be improved so that it is sufficiently detailed to make it clear what service users are eating on a daily basis and thus provide evidence that their nutritional intake is satisfactory. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 7 The provider must review the training provided to staff with regards to the administration of medication to ensure that it is adequate to meet service users’ needs and that staff have the knowledge and competence to undertake this task. Although staff are accessing formal adult protection training, incidents have arisen which have not been reported in line with local procedures. This indicates shortfalls in staff’s ability to identify incidents where service users have been placed at risk of harm and take appropriate action to report them. A requirement has been made for procedures to be reviewed to raise staff’s awareness and ensure that incidents are reported promptly to appropriate authorities. Recruitment procedures must be reviewed to ensure that all essential documentation is collected prior to staff commencing their employment at Apple House. This will help ensure the protection of service users in the home. This requirement is repeated from the last inspection of the service. Some shortfalls were identified with regards to health and safety in the home including the risks to service users in relation to hot water and training in fire safety, food hygiene and first aid for staff. A requirement around fire safety training has been repeated from the last inspection of the service to ensure that all staff undertake this training. The registered provider has responded promptly to the urgent issues highlighted so that service users’ safety and welfare in their home is maintained. Service user plans are in place but would benefit from further development to ensure they are sufficiently detailed, person-centred and in a format that is accessible to service users. Some risk assessments were seen but it was evident that not all risk assessments for one service user were on file and this should be addressed to ensure this information is available to staff. Three recommendations have been made in relation to medication practices in the home to ensure that staff have enough information available to them when administering medicines to service users. The home’s complaints procedure should be expanded to include the reporting and recording of concerns to ensure that these are responded to adequately and with positive outcomes for service users. Staff training should be reviewed to ensure that staff have opportunities to work towards nationally recognised qualifications and can access relevant training to the service user group and their respective roles. This includes access to structured induction and foundation training that meets Skills for Care standards, a recommendation which is being repeated from the last inspection of the service. This will help promote staff’s competence in their work with service users. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 8 Staffing levels should be kept under review at Apple House to ensure that the individual needs and wishes of service users can be met. The provider has started to implement the home’s quality assurance process in obtaining feedback from service users, their relatives and representatives. This should now form the basis of the home’s annual plan to ensure that service users’ views are central to objectives set regarding the home’s future development. Individual fire safety drill and training records are recommended for staff to ensure that all staff participate in the minimum number of fire drills and training sessions and therefore have the essential knowledge and skills to keep service users safe in the event of a fire. 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 House DS0000063160.V309179.R01.S.doc Version 5.2 Page 9 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 House DS0000063160.V309179.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed by prior to their admission and this ensures that suitable arrangements can be put in place at the home to meet individuals’ needs. EVIDENCE: There have been no service users admitted to the home since the last inspection of the service in February 2006. At this time, the records of a service user who had been admitted just a few days before the inspection were examined. This showed evidence of a Community Care Assessment of Needs having been undertaken by his Care Manager and assessment documentation from various health care professionals. Discussion with the service user at that time indicated that he had been involved in the process and that his needs and aspirations had been considered. During this inspection, the Registered Manager showed the inspector a sample of the home’s assessment documentation. This enables information on service users’ daily routines, religious and cultural needs, medical and health history, eating and drinking, night-time support requirements, independent living skills, activities and personal care needs to be recorded. Apple House DS0000063160.V309179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Support plans need further development to ensure that they fully identify service users’ needs in each aspect of their care, their goals, their aspirations and preferences and that they are in a format that is meaningful to the individual. Service users independence in making decisions about their daily lives is encouraged by staff and they are offered support to follow through the choices they make. Risk assessments are in place and there was evidence of them being updated to reflect the changing needs of residents. However, not all risk assessments that had been carried out were on file at the time of inspection. EVIDENCE: The support plan for one service user was examined. This had been written in January 2006. Information on the service user’s morning and night-time routine, bathing and showering, day care, independent living skills, Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 12 communication, family, mealtimes, money handling, health care needs, mobility and behaviour had been included. Attention had been given to the service user’s likes and dislikes, support needs and safety issues. Some areas of the support plan did not contain enough information to offer a full picture of the service user’s needs, abilities and preferences in each area and any goals that had been set. The plan is in written format and therefore attention to creating a format that is personal and meaningful to the service user should be considered with service users’ involvement. There was evidence that at a recent review of the service user’s needs the support plan had been shared with the relatives and Care Manager of the service user and that changes to the service user’s needs had been discussed to ensure that the service was still able to meet needs identified. It was evident that the ‘Daily Tasks’ diary of one service user in his bedroom has been converted into a visual board with velcro pictures which the service user is able to understand. Observation of staff interactions with service users indicated that service users are supported to make decisions about their lives on a daily basis. One service user responding to the survey indicated that he ‘always’ makes decisions about what he does each day. Discussion with service users and staff indicated that the home’s routines are generally sufficiently flexible to enable service users to be spontaneous about what they want to do; ‘Staff let me do what I want most of the time’. One service user spoken with stated that he wants support in moving towards greater independence. It was clear from conversation with the Registered Manager that this is being given serious consideration and the home is looking at how they can support him with this process. Another service user, who receives some 1:1 hours, reported that he will be involved in the short listing and interview process for a Support Worker who will provide this. House meetings are held every six or eight weeks to encourage service users to make decisions about meal choices and activities. The Registered Manager is looking to appoint an independent advocate to chair these meetings. A sample of risk assessments for one service user was inspected. Not all the risk assessments that had been completed were on file at the time of the inspection and the Registered Manager was advised to ensure that this is addressed as all risk assessments should be readily available for the information of staff. Of those inspected there was evidence that one had been signed by the service user concerned and one had been reviewed and updated when the service user’s needs had changed. There was evidence on file that where risks had been identified appropriate action had been taken to reduce the risk. For example, contact with the Falls Prevention Team had been made in relation to one service user with a handrail installed on the stairway to support the service user with walking upstairs and a grab rail on the bath to be installed. One risk assessment regarding a recent holiday to a holiday park had been signed but the signature was not legible. Apple House DS0000063160.V309179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to identify activities they would like to do and are given support to achieve their personal goals as appropriate their needs. Service users’ access to their community, independently, individually and in small groups is promoted so that they lead ordinary lives. Service users are supported to maintain contact with their families and the use of advocates and volunteers is being considered to expand their circle of support. Service users’ rights and responsibilities are recognised by the home and they are encouraged to make choices and decisions about issues that affect them as individuals and as a group. Service users enjoy their meals at the home but more detailed recording of individuals’ dietary intake is needed so that nutritional intake is evidenced. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 14 EVIDENCE: There was ample evidence to demonstrate that the diverse needs of the service users at Apple House had been considered in their provision of care. Support is generally very individualised with service users who are working towards greater independence being empowered to do so and service users who prefer more home-based activities offered opportunities in-house. A member of staff who has particular knowledge and skills in art therapy coordinates sessions for service users who choose to take part in arts and crafts. The home has also employed a part-time Activities Co-ordinator whose role is to offer individual time with service users on a weekly basis to enable them to do what they want to do in the community including, for example, visiting local places of interest, cafés, garden centres and shops. The home has a vehicle which enables service users to access the area. One service user who has recently passed his driving test has received support in obtaining his new licence and is to receive appropriate support to purchase a car. A conversation with the service user concerned demonstrated how important this support is to him as it will enable him to travel to his new job as a domestic at a local airport. The home has supported him in obtaining support from a specialist employment agency to enable him to achieve this goal. At the moment the service user has a bicycle which enables him to travel independently around the area and promotes his independence. Another service user spoken with is being supported to access voluntary employment in the community doing catering work which is of interest to him. All service users at Apple House recently joined service users from Apple House Limited’s other home on a week’s holiday to ‘Butlins’. One service user spoken with stated that he had really enjoyed the holiday and had been able to participate in a wide range of activities and meet new people. Another service user said that he wants to go abroad on holiday next time and had obtained a travel brochure for ideas of places to go. Discussion with service users indicated that they are encouraged to maintain contact with friends and family. One service user talked of plans to visit a family member the following week with the support of the Registered Manager. One service user who has experienced a family bereavement is supported to visit the grave of his relative which is important to him. There was evidence that service users’ rights are central to the home’s philosophy. Observation showed that service users have access to all communal areas of the home. A tour of the home demonstrated that service users are able to personalise their bedrooms as they wish and purchase items such a personal computer and television for themselves to make it homely. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 15 One service user spoken to stated that he makes choices about what time to get up in the morning and goes to sleep. Another service user was seen to be using the home’s telephone to make a personal call as this is part of the home’s policy. Two service users indicated in discussion that they want to move on to live more independently and feel that the home is supporting them with this. One service user who wants to purchase a car is receiving appropriate support to be able to do so and has contact with an independent advocate to ensure that his rights will be upheld with regards to how he spends his money. Service users are encouraged to take responsibility in maintaining their home environment, for example with gardening tasks, laundry and cooking with support from staff. The pre-inspection questionnaire supplied by the Registered Manager prior to inspection indicated that structured menus have not been encouraged in the home because they prefer to empower service users to decide on the day what they would like to eat. It was also stated that, where possible, service users shop for their meals and help prepare them. On the day of inspection, a service user was seen helping prepare the vegetables for the evening meal. There was also evidence that service users can help themselves to drinks, fruit and snacks during the day with one service user making drinks for himself and peers and another helping himself to a sausage roll as a mid-afternoon snack. Shortfalls were identified with regards to the recording of meals and snacks eaten by service users. Records were not specific enough to indicate individuals’ actual intake for example, references to ‘packed lunch’, ‘Chinese banquet’, ‘cereal’ and ‘sandwiches’. Records were often not detailed enough to indicate the fruit and vegetable intake of service users and therefore it was difficult to ascertain whether the diet provided is satisfactory. Gaps were also identified on some dates where no details of meals had been recorded. It was also unclear how all service users were involved in making decisions about what they eat. The Registered Manager reported that she would take action to ensure more detailed records were maintained and ensure that the way in which meals are planned and chosen by service users is documented. Service users spoken to reported that they liked the meals offered to them at Apple House. Staff reported that the timings of meals are flexible so that service users’ needs and preferences can be met. Apple House DS0000063160.V309179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs and wishes form the basis of their support with personal care to ensure their requirements are met in a way that they prefer. Good liaison has been established with the primary health care and specialist health care teams to ensure service users’ physical and emotional health care needs are met. Systems and training around medication practices must be reviewed to ensure that staff are fully competent to undertake this role and that service users are fully protected. EVIDENCE: Issues around likes and dislikes and support needed in personal care tasks are recorded in support plans but, as indicated in Standard 6, would benefit from some expansion to include more detail. One service user indicated in a survey that he felt staff always treated him well and there was evidence from talking with staff that personal care offered at the home is very individualised with some service users requiring more support than others. Where service users are working towards independence they are encouraged to take greater control Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 17 over their personal care needs. One service user spoken to reported that he liked it at Apple House and felt that staff respected his privacy and dignity. A social care professional stated in a comment card that ‘Apple House provides excellent standards of care using person-centred approaches; indeed the impact of the support given to a resident has helped to move him on considerably. The staff have contributed to high standards of care, support and well-being of the resident’. Records of one service user’s health-care appointments were examined. This demonstrated that the service user had been supported to attend eye tests, an audiology clinic and appointments with the primary health care team and hospital as appropriate. Since January 2006 it was apparent that attendance at health care appointments had been incorporated into daily records rather than being recorded separately. It is suggested that the home returns to a system of recording health appointments separately to ensure that enough detail is included and for ease of reference. The home’s visitors’ book showed that at various times in recent weeks, members of the Community Learning Disability Health Care Team had visited the home in relation to another service user’s welfare. One service user receives bereavement counselling on a regular basis to support him with a loss of a family member. Where there have been identified changes in the health care of one service user, there was evidence that a review meeting had taken place and issues around whether the home was able to meet the service user’s needs satisfactorily had been discussed. This is important to ensure that the service user’s changing needs are fully met. Daily records also showed that, where staff had concerns about the health of a service user, they had made frequent contact with the service user’s general medical practitioner for advice. An incident report also showed that on an occasion where a general medical practitioner had been unable to attend the home as a matter of urgency and concerns about the health of a service user were substantial, staff had contacted emergency services to ensure appropriate professional advice was sought. For one service user who was in hospital at the time of the inspection it was evident that staff at the home were making regular contact with the hospital and during the inspection the Registered Manager attended the hospital to support the service user with a clinical procedure that was due to be carried out. A recent incident report submitted to the Commission indicated that an assessment by an Occupational Therapist would be sought in relation to the needs of one service user where there have been health concerns. The Registered Manager confirmed that a chiropodist visits the home as required to support service users with foot care and regular visits are made with service users to a local dental practice to ensure their oral health is maintained. A comment card from a general medical practitioner who has contact with service users at the home indicated that the home communicates clearly with Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 18 him, that staff demonstrate a clear understanding of the care needs of service users, that specialist advice is incorporated into the service user plan and that he is ‘very satisfied’ with the overall care provided to service users within the home. Apple House has a policy on the handling and storage of medication that covers recording, administration, self-administration, over-the-counter remedies, ordering medication and training. This is accompanied by a Drug Error Policy which states the procedure to be followed in the event of a drug error being made by a staff member. Medication is stored securely in a kitchen cupboard. It was noted that the storage of medication had been reviewed since the previous inspection of the service with a larger cupboard now being used to ensure that there is sufficient space for storage. Medicines are dispensed from a local pharmacy and the home uses the Medication Administration Records (MAR) charts provided by the pharmacy. Service users’ allergies had not been recorded on the MAR charts. The home uses a monitored dosage system for most of the medication although some medicines are boxed. All staff take responsibility for administering medicines to service users once they have done the pharmacy’s short training course on the use of the monitored dosage system. There is no further accredited training in place for staff at the present time. A sample of records were checked against the mediation that has been administered. Records were seen to have been signed appropriately which suggests that medication had been given as prescribed. In recent weeks there have been incidents in the home where medication errors have occurred. Incident reports submitted to the Commission indicate that the Registered Manager is investigating these incidents and that medication procedures are being reviewed to ensure that service users’ welfare is safeguarded. A memo has been sent to all staff requiring them to read and sign the home’s medication policy to ensure that they understand the procedures and take appropriate action in the event of an error being made. It is recommended that patient information leaflets are kept for all medicines used by service users for staff reference. The home has a general example of a homely remedies list but this should be adapted to meet the requirements of the home and service users. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Expansion of the home’s complaints procedure to ensure that concerns raised are documented and followed up is needed to ensure positive outcomes are achieved for service users. Procedures and training are in place around the protection of vulnerable adults but systems must be reviewed to ensure that staff are fully competent in identifying incidents that require reporting to the authorities and do so immediately. EVIDENCE: The home has a complaints procedure that is on display in the hallway of the home. Following a requirement made at a previous inspection of the home, the Registered Manager ensured that a copy of the complaints procedure was distributed to all relatives of service users. One service user indicated in his service user survey that he knew who to speak to if he was unhappy and knew how to make a complaint. He also indicated that he felt the care workers always listen and act on what he says. Another service user stated that he would ‘talk to Jane’ if he was unhappy. The pre-inspection questionnaire states that no complaints have been received by the home in the past twelve months. However, there was evidence on file that a concern had been raised in relation to the support given to one service user and that this concern had been responded to promptly in the form of a letter by Jane Montrose. This had not been documented in the home’s complaints record. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 20 The home has a policy on adult protection and the prevention of abuse. A flowchart has been developed to show the action that must be taken in the event of abuse being witnessed or suspected. A procedure on whistle blowing is also in place. These procedures are introduced to staff at induction and there was evidence to demonstrate that the home is introducing an improved system by which staff sign to indicate that they have read and understand the policy. During the inspection the Registered Manager made the inspector aware of an adult protection issue that had not been reported at the time of the incident in line with local procedures. The Registered Manager had, however, addressed the issue through the home’s disciplinary procedures. On realising this shortfall the Responsible Individual took appropriate action in reporting the incident to the Local Authority. Recruitment procedures in the home are not currently robust enough to ensure service users are fully protected. One of the two staff files examined showed evidence that the member of staff had recently accessed introductory training on adult protection with the Local Authority. Those staff who have not yet accessed the training have been allocated to training courses taking place in the next few months. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable home that is well-maintained and allows them to exercise their personal choice with regards to the decoration and furnishing of their own rooms. Procedures around infection control are in place to ensure service users are protected from cross-infection in the home. EVIDENCE: Furnishings and fittings throughout the home are domestic and homely. Service users have been enabled to decorate and equip their rooms with personal items. Information supplied in the pre-inspection questionnaire and a guided tour of the home demonstrated that, since the last inspection of the service, a new shower has been installed in the home, a new dishwasher is in place and a new oven was due to be fitted in the next week. The home presented as well maintained and in good decorative order. Discussion with the provider demonstrated a commitment to maintaining good hygiene throughout the home. At the time of the inspection the home Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 22 presented as clean and airy. An infection control policy and hand washing procedure is in place. Aprons and gloves are accessible to staff who support service users with personal care tasks. Following the inspection the Registered Manager confirmed that the home has taken delivery of regular and antibacterial soap dispensers and paper towels for each sink in order to minimise the risk of cross-infection. Clinical waste is placed in yellow bags and locked in a separate bin for collection by a specialist clinical waste company. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is working towards ensuring that staff have opportunities to develop their knowledge and skills by undertaking nationally recognised qualifications in Care. Staffing levels should be reviewed to ensure service users do not have to go out as a group if they do not want to. Shortfalls in recruitment practices have been identified that need to be addressed urgently if service users are to be fully protected. Implementation of an induction programme that meets the new Common Induction Standards and other training for staff is needed to ensure that staff have the basic and specialist training necessary to work with the service user group and carry out their roles with competence. EVIDENCE: Of six care workers employed at the home, one has a NVQ to Level 3 standard. The Registered Manager reported that she will be establishing links with Partners in Care regarding NVQ training opportunities in the area for all staff. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 24 A copy of the home’s duty rota shows that one member of staff is employed to work a twelve hour shift during the day with one member of staff sleeping in at night. This is in addition to the regular presence of the Registered Manager, the part-time employment of an Activities Co-ordinator and part-time 1:1 Support Worker for one service user. Two service users spoken with stated that they would like there to be more staff on duty at any one time. One service user reported that on occasions service users at Apple House have joined service users at the company’s other home at weekends when he would prefer to remain at Apple House. It is therefore recommended that the provider reviews staffing levels to ensure individual service users do not have to go out as a group if they choose not to. The recruitment records of two members of staff were examined. Both were well-organised and showed proof of identity. The references for one member of staff were both from an employer for whom he had worked until March 2005 but there was no reference from his most recent employers. Enhanced disclosures from the Criminal Records Bureau were on record for both staff but were applied for in previous employment and dated September 2005 and November 2005 respectively, three and four months prior to each of them commencing employment at Apple House. Jane Montrose confirmed that she is in the process of obtaining up-to-date disclosures for all staff employed at the home using a new umbrella body. Following the inspection a letter requiring urgent action on this issue was sent to Jane Montrose. The failure to meet this standard has resulted in the overall rating for this outcome group to be assessed as ‘poor’. A copy of the guidance ‘Safe and Sound’ produced by the Commission has been given to the Responsible Individual to ensure that practices in the home meet the Regulations. An induction programme which meets the objectives of the Learning Disability Award Framework (LDAF) has been purchased from the British Institute for Learning Disabilities (BILD) with a Trainer’s Guide and is to be implemented for all staff. Jane Montrose stated that she is planning to purchase a similar foundation training package. There was evidence on the two staff files inspected that staff had received some relevant training in their previous employment but the home has yet to develop its own training programme so that it meets specific needs, for example mental health awareness and dementia. It is advised that the registered persons familiarise themselves with the new Common Induction Standards launched in September 2006, information about which can be found on the Skills for Care website. The Registered Manager has appointed a Home Manager who has some responsibility for the day-to-day running of the home and supervision of staff. The individual’s staff file did not show evidence of training in the areas of management or staff supervision to equip him for this role. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A management structure is in place that ensures clear lines of accountability and roles that meet the needs of the service users and statutory responsibilities. The home has started to implement a quality assurance process which will ensure that the home’s development is centred on the views of service users, their relatives and representatives. Some shortfalls in health and safety practices in the home were identified at inspection but prompt action by the provider is being taken to ensure that these are addressed and that service users are protected by procedures. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager, Jane Montrose, presents as committed to meeting the National Minimum Standards and has made some progress in doing so since the last inspection of the service. It was clear from observation that service users find the manager approachable and that she plays an active role in supporting the service users. There is a management structure in place that comprises of a Home Manager, Jane Montrose and the Responsible Individual, Romaine Lawson. Romaine Lawson makes monthly visits to Apple House to monitor performance. A staff member spoken to during the inspection commented that, in his view, the skills and personalities of Jane Montrose and Romaine Lawson complement each other and the management structure works well. He also reported that, in his opinion, job descriptions and responsibilities are clear and the team communicates well. Regular staff meetings and individual supervision sessions are arranged to promote communication and the sharing of information. The home has started to implement its quality assurance process with questionnaires being distributed to service users, relatives and health / social care professionals in June 2006 to obtain feedback. Areas covered in the questionnaire included the privacy of service users, belongings being treated with care, the courtesy of staff, the home’s cleanliness and décor, activities provided and choice. It was noted that feedback was generally very positive. Views expressed have been collated and Jane Montrose reported that she will be developing a response to the issues raised and producing an annual development plan for the home. A sample of health and safety records was inspected. A fire risk assessment was carried out by a fire safety consultant in April 2006. Jane Montrose confirmed that the home is carrying out recommendations made in this risk assessment. Records showed that three staff attended fire safety awareness training in March 2006 but that two staff have not yet received this formal training. At the time of the inspection, the Registered Manager made contact with the training provider to arrange a second module of fire safety training for all staff and both modules for staff who had not attended the first. Urgent action has been required on this issue and the training has now taken place with the majority of staff attending. Discussion with the Registered Manager indicated that quarterly servicing of the home’s smoke detector system is carried out, the most recent check being in May 2006. A conversation with the fire safety consultant who has risk assessed the premises indicated that this is satisfactory. The pre-inspection Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 27 information supplied by the provider indicates that the most recent fire drill was carried out in July 2006. Water temperatures were checked with the inspector putting her hand under running water from the hot tap of three sinks in the home. There was no evidence at the home that water temperatures are checked and recorded on a regular basis to ensure temperatures remain constant. Following the inspection a letter was sent to the provider to require urgent action on this issue. The provider has since contacted the Commission to advise that arrangements have been made for thermostatic valves to be fitted on all hot water outlets to ensure that water is of a safe temperature. Of the two staff files examined, one showed evidence of them undertaking moving and handling training, one staff member had a food hygiene certificate. Neither file showed evidence of the staff having undertaken first aid training. Risk assessments are in place for various chemical substances used in the home to ensure that they are used appropriately and with due regard for the safety of service users and staff. Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 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 2 33 2 34 1 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 1 X Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Records of the food provided for service users must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and otherwise. All staff with responsibility for administering medication to service users must undertake suitable accredited training. Arrangements in place for reporting incidents where a service user may be at risk of harm or abuse must be reviewed. All staff must be made aware of adult protection and whistleblowing procedures and take appropriate action to ensure incidents are reported in accordance with local procedures. The registered person must ensure that there is full and satisfactory information available in relation to all persons working in the care home in accordance with Schedule 2 of the Regulations. This requirement is repeated from the last inspection of DS0000063160.V309179.R01.S.doc Timescale for action 1. YA17 17(2) Sch. 4 01/11/06 2. YA20 13 01/12/06 3. YA23 13 01/11/06 4. YA34 19 01/11/06 Apple House Version 5.2 Page 30 5. YA42 13 6. YA42 23 7. YA42 13 the service as the previous timescale of 30/04/06 was not met. The registered person must take appropriate action to ensure that the risks of scalding to service users in the home are minimised. The registered person must make arrangements for all persons working at the care home to receive suitable training in fire prevention. This requirement is repeated from the last inspection of the service as the previous timescale of 23/02/06 was not met. This requirement now applies to a minority of staff who have not attended training when this has been arranged by the provider. The registered person must ensure that all staff undertake training in food hygiene and first aid including updates as appropriate. 06/09/06 01/10/06 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Service user plans should contain more detail about their personal care needs so that the support they require with each task is clearly specified. 1. YA6 Personal goals should be identified in the plan with reference to the support needed for these to be met. Service user plans should be in a format that is meaningful for the individual. The registered person should ensure that all risk DS0000063160.V309179.R01.S.doc Version 5.2 Page 31 2. Apple House YA9 assessments undertaken for individual service users are kept on file so that they are available for the information of staff. All risk assessments should be clearly signed and dated. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. Patient information leaflets regarding service users’ medication should be included in their records to provide information for staff. The homely remedies list should be adapted to contain details of all over-the-counter medicines used at the home. This should include information about the dosage, indications and contra-indications for each medicine. Service users’ allergies should be added to the medication administration records. The home’s complaints procedure should be expanded to include the reporting and recording of concerns. All records of concerns should be kept together with complaints in a specific file for that purpose. All care workers at the home should have achieved, or be working towards, an NVQ qualification of at least Level 2 standard. The registered person should keep staffing levels under ongoing review to ensure that service users’ individual needs can be met by the home. The registered person should ensure that staff receive structured induction and foundation training which meets the specifications of Skills for Care. This recommendation is repeated from the last inspection of the service. 7. YA35 Specialist training should be arranged for all staff to ensure that they are able to meet the individual needs of service users, for example, training in mental health awareness and dementia. Staff who have responsibility for leading or supervising staff should have suitable training to be able to do so. The registered person should produce an annual development plan for the home based on the views of service users as obtained through the quality assurance process. Individual fire training / drill records for staff are recommended so that gaps in training and participation in drills are easily identified. DS0000063160.V309179.R01.S.doc Version 5.2 Page 32 3. YA20 4. YA22 5. 6. YA32 YA33 8. YA39 9. YA42 Apple House Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Apple House DS0000063160.V309179.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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