Inspection on 16/07/07 for Apple House

This inspection was carried out on 16th July 2007.

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 10/08/06

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 16th July 2007 09:10 Apple House DS0000063160.V345089.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.V345089.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.V345089.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.V345089.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. 10th August 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 home 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 which is also on the first floor. 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 assessed needs. Up-to-date information on current fee levels has not been provided by the home for the purpose of this report. Guidance on fair terms in care homes contracts may be obtained from the Office of Fair Trading – www.oft.gov.uk Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service. The inspection took place over approximately nine hours on 16th and 19th July 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last key inspection of the service in August 2006 and a specialist inspection by the Commission’s Pharmacist Inspector in September 2006. At the time of this inspection there were two people living at Apple House. During the inspection we were able to take a guided tour of the home, meet both people who use the service and observe some interaction between them and staff. Discussion took place with the Responsible Individual for the home, Mrs Romaine Lawson. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment (AQAA) was completed by the provider and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care managers and health care professionals on behalf of the Commission. A total of four surveys were received and information from these sources is reflected throughout the report. A total of twenty-three standards were assessed at this inspection. What the service does well: The home makes sure that people’s needs have been assessed before they are offered a place in the home. This ensures that people’s needs can be met by the service and that Apple House is a suitable place for them to live. People who use the service are given opportunities to make choices and decisions about their lives. They receive a service that is person-centred and that promotes their independence. Routines in the home are flexible and enable people to live ordinary lives in their home and community. People are enabled to do activities, go to places that are of interest to them and maintain relationships with friends and family. People enjoy the meals that are offered to them and are able to get involved in choosing and preparing the food they eat. People who live in the home told us; ‘Apple House is a nice place to live’; Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 6 ‘I like Apple House and I don’t want to move. I like my room and all the staff let me do what I want.’ Positive comments about the home were also received from a family member of a service user who indicated that their relative’s move to Apple House has been ‘the best thing that has happened for him’. Apple House provides a clean, homely and comfortable environment for people to live in. People who use the service and their relatives / representatives are consulted about the service they receive. Their feedback is used to set objectives for the development of the home to ensure that it is run in their best interests. What has improved since the last inspection? The provider has taken steps to address most of the requirements made at the last inspection. There has been more effective reporting of adult protection concerns and the provider has liaised with appropriate statutory bodies where this has been necessary. Staff have attended training in abuse awareness so that they know what to do to keep people safe. Recruitment records for permanent staff seen at this inspection showed evidence of appropriate checks having been undertaken to confirm their suitability to work with vulnerable adults. Appropriate action has been taken by the provider with regard to ensuring water temperatures in the home are safe. Thermostats have been fitted to outlets and temperatures are checked on a regular basis to minimise the risk of scalding. Permanent staff in the home have now attended fire safety training although the provider must continue to ensure that they attend updates when these are organised. Food hygiene training has also been provided to staff to promote good practice in this area and ensure people who use the service benefit from food that is prepared safely. Records of meals provided to people who use the service have improved although the home needs to ensure that they also record snacks to ensure that they can provide an accurate account of what people are eating each day. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 7 What they could do better: As a result of this inspection, seven requirements and nine recommendations have been made. Two of the seven requirements are repeated from the last inspection of the service. Continued work is needed to ensure that support plans contain enough information to clearly indicate the support that people need in their everyday lives and with regards to their health and medication needs. Support plans should be in an accessible format to aid people’s understanding and all information relating to service users’ needs must be kept securely to ensure that they cannot be read by others. The home must ensure that all staff with responsibility for administering medication to service users have had suitable training to do so. In-house training should also be recorded so that there is evidence that all care workers, including agency workers, are aware of the procedures they must follow and that they are competent to give medication safely. At the time of the inspection the home was using a high number of temporary staff supplied by an agency. A requirement has been made that the home must employ enough permanent care workers to ensure that consistency and continuity of care for people who use the service is promoted. Since the inspection, the Registered Manager has informed the Commission that this has now been addressed and two additional permanent care workers have been employed. A further requirement has been made that, where agency staff are used in the home, the provider must assure themselves that each agency worker has been subject to suitable pre-employment checks. This will help ensure that service users are protected by the people employed to work with them. Although a framework is in place for recording that temporary care workers in the home have been instructed on the home’s fire safety procedures, this has not always been completed. The provider must ensure that they can provide evidence that temporary care workers have received this information and know what to do in the event of a fire. In addition, although the home carries out fire drills at various times of day, they need to ensure that night staff also have the opportunity to participate in drills and know what action to take to evacuate the home at night. All staff must also have up-to-date training in first aid so that they can respond safely and effectively in emergency situations. Further development of the home’s complaints procedure has been recommended to ensure that it is in an accessible format for people who use the service and that the outcome of complaints and concerns is clear. Continued investment in training is also needed to ensure that staff with management and supervisory responsibilities are fully equipped for their role Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 8 and that all staff in the home undertake National Vocational Qualifications in Care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apple House DS0000063160.V345089.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.V345089.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs and wishes are assessed before they move into the home which ensures that the service can meet their needs and a smooth transition is promoted. EVIDENCE: Since the last inspection of the service there has been one new person admitted to Apple House. There was evidence on record that information about the person’s needs had been gathered prior to admission from a variety of sources including the service user, their family, their previous placement and the local authority. There was a care management assessment on file from the local authority and evidence that the home had carried out their own assessment. This took into account the person’s needs and preferences in areas of care including medical arrangements, meals and dietary requirements, morning and evening routines, personal care, daily living tasks and religious / cultural needs. The document had been signed by the service user and the member of staff involved in its completion. Records also indicated that the service user had visited the home prior to admission including overnight stays. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service provided to people who live at the home is tailored to their individual needs and aspirations. However, some improvements in documentation are needed to ensure that there is clear information on the support that people need in their daily lives. EVIDENCE: A sample of support plans were seen. These included ‘Essential Lifestyle Plans’ containing information about people’s circle of support, likes and dislikes, communication, behaviour, activities and routines. It was recommended that some information in the plan seen could be expanded. For example, where one Plan said ‘I awake at 6am, I have a wash, I clean my teeth and have a shave….I have breakfast and take my tablets.’ The level of support that the person requires with these aspects of care could be added to ensure that it is clear whether the person undertakes these tasks independently or needs staff Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 12 support. Another plan seen contained a good amount of detail and had some specific information about the action that staff need to take to support the person; ‘Please can you talk clearly and fairly loudly because I have difficulty hearing’. Plans seen were handwritten and it is recommended that the home consider ways to promote their accessibility. It was also suggested that where service users have lots of information in various documents, this is amalgamated into one comprehensive document. Mrs Lawson reported that work is underway to achieve this. Discussion with people who use the service indicated that they are able to make decisions and choices about their daily lives. It was clear from observation that routines in the home are flexible and the service that is provided is very much around the needs of the individual. This was echoed by a service user’s relative who stated in a survey that the home is ‘customeroriented to each resident’s particular needs’. One person spoken with said that he wanted to watch his favourite programme on television before going out. It was clear from discussion that this is an established part of his routine and is respected by staff. Service user meetings are held in the home. Minutes from meetings were seen, these demonstrating that people’s views are sought regarding the home, activities, holidays, meals, people moving out and moving in and sharing of domestic tasks. Minutes have been recorded in a notebook and were handwritten by staff. It is suggested that the home ensures that the minutes of meetings are accessible to service users so that they can read them following the meetings. A sample of risk assessments was seen. A framework is in place for identifying risks and detailing the action to be taken to reduce the risk. These covered areas including climbing stairs, making a cup of tea and accessing the community. It was evident from discussion with one service user that his independence in the community is promoted and he is enabled to take appropriate risks for this to happen. A relative commented that the home is supporting their family member to develop appropriately in a way that is ‘stretching but not unachievable’. Risk assessment documentation seen during the inspection had been handwritten and was difficult to read. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service enjoy flexible routines that enable them to live the life they choose and participate in their community. EVIDENCE: Discussion with people who use the service indicated that they are able to make choices about their activities. One person spoken with told us that they have a very busy life going to college and doing work experience. They said that they had done these activities before coming to live at Apple House and had been able to continue with them. It was evident from discussion with the person and inspection of records that they have been supported to learn the local bus routes and obtain a bus pass so that they can get to work independently which is very important to them. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 14 One person told us that they are a member of a self-advocacy organisation and would be going to a disco with their friends that evening. They also told us that they would be going to the gym at a local leisure centre the following week and that a member of staff would be going with him. Records indicated that people have been supported to go to local places of interest including the ‘Oceanarium’, Monkey World and a museum. They are also discussing the possibility of going to London for the day. The home has a passenger vehicle to enable people to go out on a regular basis but close proximity to a bus route means that public transport is also used. One person told us that he has a friend who lives in a nearby care home whom he meets up with on a regular basis for a game of pool at the pub. They also told us that they see their brother on a regular basis. Discussion with staff indicated that where people have friends and family, their contact with them is supported. Comments made by a relative of a service user in a survey indicated that they feel they have a good partnership with the home in looking after their relative’s welfare and that there is ‘good communication both ways’. Observation of people’s lifestyles in the home indicated that they are enabled to lead an ordinary life and use all resources in their community. Routines in the home are flexible enough to be tailored to individual’s needs and wishes, for example, they can get up when they want and have meals and snacks when they wish. Service users have access to all communal areas of the home. It was evident from minutes of residents’ meetings that people are encouraged to take responsibility for some domestic tasks in the home, for example, taking turns washing the dishes and putting the bins out. People are also encouraged to do their laundry with staff support, help with cooking and hoovering. Both people living in the home told us that they liked the food provided. One person commented that their favourite meal is steak and they get to have this at Apple House. Some specific likes and dislikes were seen to be recorded in care plans, for example ‘I always have muesli and two coffees (white, no sugar)’. Observation showed that people are able to eat breakfast at different times and help themselves to drinks and snacks as they want them. A record of meals eaten by each resident is maintained in the home in their daily diaries although it was noted that details of snacks eaten would be included in the text rather than with the main meals. From the records seen it was evident that where people wanted to eat different things this had been provided. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although people receive the support they need with their personal care and health care, improvements in documentation will ensure that there is evidence to support this. EVIDENCE: Both people who live in the home told us that staff treated them well and they felt well cared for. It was evident that service user plans include information about people’s preferences in relation to their personal care including, for example, what time of day they prefer to have a bath or shower. Discussion with staff indicated that where people are able to be independent in aspects of their personal care this is promoted. As stated in the section of ‘Individual Needs and Choices’ the level of support required by each person could sometimes be more effectively documented so it is clear in all cases the exact support that is needed and that all this information is included in one document. Comments from a relative in a survey indicated that the home Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 16 always gives their family member the support they need; ‘I think they exceed our expectations’. Documentation with regards to individuals’ health care needs was inspected. The appointments record for one person indicated that they had attended appointments with various health care professionals including their general medical practitioner, specialist nurse, speech and language therapist, dentist and audiology clinic. The outcome of appointments had not always been detailed in this record. It was evident in an incident report that where a person had needed urgent medical attention the emergency services had been contacted. A general medical practitioner responding to a comment card indicated that the home communicates clearly and works in partnership with them and that staff demonstrate a clear understanding of the care needs of service users. Discussion with staff and review of records showed that they are monitoring specific issues in relation to a service user’s eating and drinking. A plan has been put in place to minimise the risk of a service user choking although this was on display in the dining area. The home was reminded of the need to ensure that such personal documentation is kept securely. For one service user there was evidence on file that monitoring of their physical and emotional health was an important part of their care needs and there was some information detailing how the home would support this, for example, by ensuring that they take their medication, by giving the person regular opportunities to express any worries they may have and by liaising with health care services. The plan stated that if the person’s behaviour or moods became unstable contact should be made with the specialist health care team. Mrs Lawson gave a comprehensive verbal description of signs that would indicate that the person’s health might be deteriorating but this had not been documented on their care plan. In addition, there was no reference in the care plan to the fact that the service user has a diagnosis of epilepsy although this is stated in the core assessment undertaken by the local authority. Since the last inspection the medication policy in the home has been updated. Medication in the home is stored in a lockable cupboard in the home’s kitchen. The majority of service users’ medication is supplied in monitored dosage systems by a local pharmacy. Medication administration record (MAR) charts are also printed by the pharmacy. A sample of MAR charts were checked, these showing that medication had been signed for by the member of care staff responsible for its administration. Inspection of service users’ care plans indicated that there is some information available to care workers about the support needed by people in relation to their medication but it is recommended that this is expanded. For example, ‘I need to be reminded to take my medication’ and ‘I have breakfast and take my tablets’ do not provide enough information to ensure that the role of the care worker is clear. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 17 It was discussed that medication is checked by the outgoing and incoming member of staff at shift handover to ensure that it has been appropriately administered. Records are in place to support this. It was reported by the provider that this was proving to be an effective audit trail. Where service users do not have allergies this had been recorded on the MAR chart. Changes made to the MAR chart had been double-signed by two staff. The home has a homely remedies list in place but it was discussed that some further information could be included on this regarding dosage and contra-indications. Patient information leaflets were available for prescribed medication used by service users. The medication training records for three permanent members of staff in the home were checked. Two of the three had undertaken training with the pharmacy. Mrs Lawson stated that the third member of care staff had been booked onto training later in the month. It was reported that this member of staff would have undertaken in-house training and agency workers who come to the home are also provided with basic information on service users’ needs in relation to medication. However, this in-house training had not always been recorded and therefore it was not clear who had been given in-house training, the content of this training and the qualifications and experience of the trainer. No formal training has been provided to ensure staff are competent in checking the blood sugar levels of one service user although the provider confirmed that written procedures are in place. At the time of the inspection Mrs Lawson was meeting with a trainer who provides training in medication administration to care workers at the home. Mrs Lawson reported that they have identified that the training provided to care workers to date needs to be more tailored to procedures within the home and therefore they are looking to adapt the training to meet this need. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to have their say and are listened to but development of some procedures is needed to ensure that people who use the service are fully protected. EVIDENCE: A copy of the home’s complaints procedure was seen on display in the hallway of the home. This incorporates the reporting of concerns to the home and gives the details of the Commission. The procedure is not currently in an accessible format – this has already been identified as an area for development by the home who plan to work with an advocacy group to develop a more user-friendly format. Both service users responding to their survey told us they knew who to speak to if they are unhappy. Minutes of service user meetings also suggest that service users’ views are sought on a regular basis and they are listened to by staff. A relative of a service user indicated in a survey that they are aware of the home’s complaints procedure. The home’s complaints record was reviewed. Three complaints had been recorded since the last inspection, two of which were in relation to people who had accessed the service for a respite stay. It was noted that the recording of complaints could be expanded to give more information about the final outcome and whether the complainant was satisfied with the home’s response. The Commission has received no complaints about the home since the last inspection. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 19 Information from the home’s Annual Quality Assurance Assessment (AQAA) indicates that the service has a policy on safeguarding adults and the prevention of abuse that was last reviewed in March 2007. The provider also told us in the AQAA that two adult protection referrals have been made in the past twelve months. Relevant statutory agencies have been involved in the investigations of both issues and the Commission was informed. A sample of staff training records was seen, these showing that staff have attended relevant training in abuse awareness. The provider has told us in the AQAA that they plan to provide more training for care staff and residents around reporting abuse. At the time of the inspection the home were using agency staff on a regular basis. Mrs Lawson reported that, as part of the contract the home has with the agency, all staff have undergone appropriate checks with the employing agency to ensure their suitability to work with vulnerable adults. However, the home did not have enough documentation to evidence this. The provider was reminded that it is their responsibility to ensure that the employing agency has undertaken appropriate checks and they must have written evidence to support this. This is particularly important as at Apple House care workers are generally lone-working and not supervised by a permanent member of staff. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Apple House meets the environmental needs of the people who live there and offers a homely and comfortable place for them to live. EVIDENCE: Apple House is an ordinary semi-detached property along an ordinary street in a residential suburb of Bournemouth. It is comfortably furnished with a homely atmosphere. All fittings are domestic and appropriate to the nature and purpose of the home. A service user spoken with during the inspection showed us their room and told us they liked it. They have been able to personalise their room as they wish. Another service user told us that he thought his room was comfortable. A tour of the premises indicated that the paper on the ceiling of the laundry area was coming away. A review of the inspection report by Environmental Health carried out in February 2007 also indicated this. Since the inspection, Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 21 the Registered Manager, Mrs Jane Montrose, has informed the Commission that this will be addressed promptly. At the time of the inspection the home presented as clean. In the home’s Annual Quality Assurance Assessment they informed us that they have a policy for preventing infection and managing infection control. Of two staff files seen, both had attended training in infection control. Liquid soap and paper towels were seen to be available at wash hand basins in the home. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive some training to enable them to develop competence in their roles. However, at the time of the inspection, there were not enough permanent staff employed at the home to promote consistency and continuity of care for people who use the service. EVIDENCE: Discussion with Mrs Lawson indicated that the home is committed to making contact with local training initiatives and providers to ensure that staff receive training for their role. Out of three permanent staff working at Apple House, one was reported to have obtained a National Vocational Qualification (NVQ) at Level 3. A second care worker is currently working towards an NVQ Level 2. The service has a ‘Home Manager’ who shares some day-to-day management responsibilities with the Registered Manager. The Home Manager has recently completed an introductory certificate in first line management but does not have a National Vocational Qualification in Care or Management. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 23 Review of the staff rota demonstrated that care workers at the home generally work a twelve-hour shift pattern. Shifts are usually covered by one care worker. It was evident that in the two weeks prior to the inspection a total of twelve shifts had been covered by staff who were not permanent care workers in the home. The majority of these were agency workers. In particular, on one weekend, both days and nights had been covered by agency workers which meant that people who use the service had not had contact with permanent staff for a whole weekend. This was raised as an area of concern with Mrs Lawson who reported that the home were liaising with an employment agency to recruit additional permanent members of staff to work in the home. Since the inspection, the Registered Manager has informed the Commission that two additional permanent staff have been recruited to work in the home. Staff working at the home are supplied by an agency who undertake all prerecruitment checks prior to care workers commencing work with service users. A sample of permanent staff files were checked for evidence that appropriate checks had been carried out. These were found to be satisfactory showing evidence of written references, proof of identity and an enhanced disclosure from the Criminal Records Bureau. However, there was insufficient evidence available at the home at the time of the inspection to demonstrate that appropriate checks had been carried out on individual agency workers. A requirement has been made under Regulation 19(4) for this to be addressed as this potentially impacts on the protection of vulnerable adults. A sample of staff training records was seen. A programme of staff training is in place which includes aspects of health and safety training and training in bereavement. The home’s Annual Quality Assurance Assessment indicates that they plan to provide specialist training to staff about mental health issues. It was discussed that the home should also look into providing staff with training in epilepsy to ensure that they have the knowledge and understanding to be able to support people with this condition. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Registered Manager is competent and able to run the home effectively. However, some shortfalls have been identified with regards to staffing and health and safety training which need to be addressed for the welfare of service users to be fully protected. EVIDENCE: At the time of the inspection the Registered Manager of the home, Mrs Jane Montrose, was on maternity leave. The Commission was informed of the interim management arrangements for the home. Mrs Lawson is the Responsible Individual and has overseen the management of the home in the Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 25 Registered Manager’s absence. She has maintained good communication with the Commission about issues arising in the home. Mrs Lawson also undertakes monthly visits to the home as part of the home’s overall quality review process. Although progress has been made in meeting six of the eight requirements made at the last inspection of the service, two requirements have been repeated from the where timescales have not been fully met. The Registered Manager is a qualified adult nurse. It is recommended that she undertakes the NVQ Registered Manager’s Award and that other staff who have supervisory and management responsibilities in the home are also supported to undertake further qualifications to equip them for their individual roles, for example, facilitating staff supervision and appraisal. Quality assurance surveys were distributed by the home to service users, their families and health and social care professionals in 2006. Surveys asked people for feedback on various aspects of the service including the quality of the accommodation offered in the home, the activities and how staff respect the privacy, dignity and independence of people who use the service. Feedback has been collated in the form of a service development plan for 2007 which outlines how the service aims to improve. It was noted that the service development plan covers outcomes and objectives for both homes in the Apple House Limited group. It is therefore suggested that the provider considers separating these into two plans as the outcomes for each home may be different and objectives set should be specific to each home. A sample of health and safety records was inspected. Since the last inspection thermostats have been fitted to water outlets to control water temperatures. Records seen indicated that temperatures are checked and recorded by staff on a daily basis. Documentation showed that regular checks on smoke detectors are also undertaken. A fire risk assessment was undertaken at the home in April 2006 by an external fire safety agency who also provide staff with fire safety training. Mrs Lawson reported that two modules are undertaken during the course of a year. Of the three permanent staff working at the home at the time of the inspection, two were recorded as having received this training. The third member of staff was recorded as having completed an alternative fire safety training course in February 2007. A framework for recording in-house fire safety training for temporary workers is in place but had not been completed in all cases. Fire drill records from October 2006 onwards were seen, these indicating that practice evacuations are carried out on a regular basis in the home. According to the records, both of the people living in the home had been able to participate in practice evacuations, these timed to occur at various times of the day between 8am and 7pm. There was no record of drills being carried out after 7pm or when night staff would be on duty. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 26 Training in food hygiene, health and safety, moving and handling and basic first aid is provided to staff by an external agency. Of the three permanent staff, only one was documented as having completed basic first aid training. The remaining two care workers had been booked onto a first aid course in August 2007. It was discussed with Mrs Lawson that the home must ensure that all staff attend mandatory training and updates as required, this being of particular importance as care workers are frequently working alone in the home and therefore must know what action to take in an emergency situation. Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 27 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 2 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 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 15(1) Requirement The registered person must ensure that the service user plan contains sufficient information to show how service users’ health care needs are to be met. The registered person must ensure that records in respect of each service user are kept securely in the care home to protect people’s confidentiality. All staff with responsibility for administering medication to service users must undertake suitable accredited training so that they are able to do so safely. This requirement is repeated from the last inspection of the service as the previous timescale of 01/12/06 was not fully met. 4. YA23 19(4) The registered person must ensure that they obtain sufficient evidence that suitable preemployment checks have been carried out on agency workers prior to them coming to work at the home and that they are safe DS0000063160.V345089.R01.S.doc Timescale for action 01/12/07 2. YA19 17(1)(b) 01/10/07 3. YA20 13(2) 01/11/07 01/10/07 Apple House Version 5.2 Page 29 to work with vulnerable adults. 5. YA33 18(1) The registered person must ensure that there are enough permanent staff employed at the home to ensure service users receive continuity of care. The registered person must ensure that temporary workers are given instruction on the home’s fire safety procedures as soon as they come to work at the home and that this is clearly documented. All staff working at the home must have the opportunity to participate in practice evacuations to ensure that they are aware of procedures. 7. YA42 13(4) The registered person must ensure that all staff undertake training in first aid including updates as appropriate. This requirement is repeated from the last inspection of the service as the previous timescale of 01/11/06 was not fully met. 01/11/07 01/10/07 6. YA42 23(4A) 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 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. Service user plans should be in a format that is meaningful Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 30 for the individual. 2. 3. 4. YA9 YA19 YA20 Information written in risk assessments should be legible and easy to read. The outcomes of service users’ health care appointments should be more fully documented. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. Service users’ support plans should contain more specific information about the support needed by individuals to take their medication safely and effectively. The homely remedies list should include information about the dosage, indications and contra-indications for each medicine. In-house training on medication administration should be recorded and a system put in place to assess people as ‘competent’ to administer medicines to service users in the home. Where service users require support with specific procedures, such as checks on their blood sugar levels, staff should be assessed as competent to do this. The home’s complaints procedure should be put in a format that is accessible to people who use the service. Recording of the outcome of complaints should be expanded to detail action taken by the home and the complainant’s satisfaction with this. All care workers at the home should have achieved, or be working towards an NVQ in Care of at least Level 2 standard. Specialist training that reflects the specific needs of service users should be provided to care workers. The Registered Manager should undertake the NVQ Registered Manager’s Award. Staff with supervisory and management responsibilities in the home should be given appropriate accredited training to fully equip them for their role. Fire drills should take place at variable times of the day including times when night staff are on duty in the home. 5. YA22 6. 7. 8. YA32 YA35 YA37 9. YA42 Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Apple House DS0000063160.V345089.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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