Inspection on 31/07/08 for Apple House

This inspection was carried out on 31st July 2008.

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

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple House 16/07/07

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 06/02/2009.

CARE HOME ADULTS 18-65 Apple House 186 Seafield Road Bournemouth Dorset BH6 5LJ Lead Inspector Heidi Banks Unannounced Inspection 31st July 2008 13:20 Apple House DS0000063160.V365977.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.V365977.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.V365977.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.V365977.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. 16th July 2007 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 shower room and toilet 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. The basic fee for service users at Apple House is £735 per week. Further general information about fees and fair terms of contracts may be obtained from the Office of Fair Trading - www.oft.gov.uk . Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection of the service. The inspection took place over approximately eight hours on 31st July and 4th August 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the seven requirements made at the last key inspection in July 2007. At the time of the inspection there were four people living at Apple House aged between 50-62 years. During the inspection we were able to meet some of the people who use the service and observe interaction between them and staff. Discussion took place with the Responsible Individual, Romaine Lawson, and some members of staff in the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were given to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received four surveys from people who use the service; three surveys from relatives, two surveys from care workers and two surveys from care professionals who have contact with the home. We received the home’s Annual Quality Assurance Assessment when we requested it which gives us some written information and numerical data about the service. A total of twenty-four standards were assessed at this inspection. What the service does well: The home demonstrates some very positive outcomes for people who use the service in terms of promoting choice, consultation and a person-centred approach to care. There is evidence that people are consulted before they move to the home and given opportunities to ‘test-drive’ the service to ensure it is the right place for them. People are empowered to lead ordinary lives and take reasonable risks so that their independence is promoted and they are able to fulfil their goals. Individuals have been supported in developing networks of support around them including family, friends and advocates and are involved in decision-making processes in the home. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 6 People who use the service are listened to and know who they can speak to if they wish to complain. Procedures are in place to ensure that people are safe in the home. Apple House is an ordinary house along an ordinary street. It is homely, bright, airy, comfortable and clean, providing a suitable environment for the people who live there. People who use the service told us; ‘It’s a nice place’ ‘I think it’s running well. The staff are very good. I would recommend it.’ ‘Apple House is alright thank you’. The home has a quality assurance process that is based on the views of people who live there. This ensures that people’s views are central to the development of the home. Health and safety checks are carried out on a regular basis to ensure that people are safe in the home. What has improved since the last inspection? What they could do better: The main weaknesses identified at this inspection were in relation to documentation around people’s health care needs and staffing. Requirements in relation to both areas were made at the last inspection of the service a year ago and are being repeated at this inspection as the provider has not taken enough action to address the shortfalls. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 7 When we looked at people’s care plans on the first day of the inspection they were not organised well enough to provide clear information to care workers. By the second day of the inspection the home had taken action to address some of the shortfalls identified but a few gaps remained in relation to people’s health care needs. Although we received feedback that the home communicates well with care professionals there was evidence of a missed dental appointment, an absence of any information around foot and nail care and inconsistencies in care planning information. This meant that we could not be sure that people’s needs were always met appropriately. The registered provider must ensure that these areas are addressed and that they audit paperwork in the home on a regular basis to identify and respond to any gaps. The staffing arrangements in the home are unusual in that the majority of people who work in the home are employed by an agency that supplies care workers to the home. Our concern in relation to this is the impact on consistency and continuity of care for people who live there. Some care workers do not work at the home on a regular enough basis to have a thorough and ongoing knowledge of people’s needs which is essential given that they work alone in the home. In addition, although care workers have received basic induction training through the agency and receive an orientation to the home itself they do not always have the opportunity to shadow more experienced staff when they start work. This needs to be addressed so that the home can demonstrate that they are giving appropriate support to new care workers and that they are supervised until they are deemed competent to work alone. The provider must also demonstrate that care workers have all the training they need to be fully equipped to understand and meet the specific needs of people who use the service. The registered provider is proposing to register the Home Manager with the Commission. We agree that this is appropriate given that the Home Manager is more ‘present’ in the home than the Registered Manager and is taking on increasing responsibility for the day-to-day management of the home. Five requirements have been made as a result of this inspection. Requirements must be addressed for the home to comply with the law. Eight recommendations have also been made. Recommendations are good practice and should be given serious consideration by the registered provider to ensure that best outcomes are achieved for people who use the service. 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.V365977.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 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 are fully involved in making the choice to live at Apple House and are given opportunities to ‘test drive’ the service to ensure that it is the right place for them. EVIDENCE: The home’s Annual Quality Assurance Assessment told us that two people have moved to the home in the last twelve months. It was apparent at the inspection that both of these people had transferred from the provider’s other residential care home located approximately two miles away from Apple House. Both individuals were already known to the service and arrived with an existing care plan. We spoke with one person who told us that it was his choice to move to the home and he had been able to visit Apple House and meet the other residents beforehand. Records we looked at showed evidence of a series of ‘transition visits’ including day visits and a weekend stay. Approximately two months after moving in the person had been supported to complete a questionnaire by staff about how he felt he had settled in. Talking to the service user concerned Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 10 it was clear that he was happy about the move and felt he had made the right choice. A care manager who responded to our survey indicated that the service’s assessment arrangements always ensure that accurate information is gathered and the right service is planned for people. Apple House DS0000063160.V365977.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 home does well in promoting people’s rights, needs and choices in their daily lives and there are some very positive outcomes for individuals in these areas. However, some aspects of documentation need improvement to ensure that care plans always contain consistent information about people’s needs. EVIDENCE: On the first day of the inspection we asked to look at a sample of care plans for people who live in the home. The Home Manager told us that information about each person who uses the service could be found in three separate files – an Essential Lifestyle Plan, a support plan and a third file which was reported to contain essential information about each person to be read by new staff or agency staff who may not be familiar with their needs. We looked at a sample of these files and found that information between them was not always Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 12 consistent. For example, a plan for one person said ‘At about 6.30pm I like to have a shower and that is when I need you to assist me to wash my back and help me with my hair wash’. Another file for the same person said ‘I can shower and bathe independently but you must check the water temperature for me’. This was queried with the Home Manager who told us that some information on the file was from the person’s previous placement. We advised the home to review the information held about each person to ensure that ‘old’ information that is no longer relevant is archived and current information is organised so that it is very clear to the reader what the individuals’ needs are and how these are to be met. We also noted that between the different files there was some duplication of information. Although there was evidence of some information being updated, information had not always been updated across all three files. This meant that there was some conflicting information about people which is potentially confusing to the reader and information was difficult to follow. We advised the home to review the systems in place to ensure that they are streamlined, in a logical sequence and that unnecessary duplication is avoided. When we returned to the home on 4th August we saw that progress had been made in re-structuring the records and, as a result, information was more effectively organised. We noted that there was some good information about people’s likes and dislikes and some relevant information about how to communicate effectively with individuals. For example, one plan said ‘I can communicate verbally very well. I like eye contact and time to express my point. I need people to speak up…as I am hard of hearing’. The plan also gave some ideas about topics of conversation the person was interested in, all of which were relevant to the service user concerned. We noted that there was still some conflicting information on record in relation to people’s health care needs which is explored more fully in the section on ‘Personal and Health Care Support’. Two care workers who responded to our survey indicated that they were always given up-to-date information about people’s needs; ‘the needs of the residents are fully documented in the care file and are reviewed regularly’; ‘we have to sign care plans weekly to confirm we have read them’. Out of three relatives who also responded to our survey, one told us that the home always met the needs of their family member while two indicated that this was usually the case. Two care professionals told us that the home does well in responding to people’s different needs. One care professional reported that they had observed the person they have contact with being treated very much as an individual and enabled to have their own routines within the home, even where this differed from the needs of others. Observation at the inspection fully supported this. It was clear that individuals’ needs were respected by the staff on duty, that they were able to make choices about what they did and when they did it. Care workers who responded to our survey echoed this by saying that the home does well at offering a person-centred service. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 13 We looked at a sample of minutes from residents’ meetings. We noted that various issues had been discussed including menu choices, trips out, household chores, holidays and activities and people had been able to contribute to decision-making and enabled to voice their opinion. Some of the people who use the service have contact with advocacy organisations and have personal advocates to ensure their views are heard. We are aware from the surveys we received from people who use the service that the Home Manager had supported each person in completing them. We suggested that the home ensures that people are supported to do this by someone who is external to the service so that people are enabled to express their views independently. We looked at a sample of risk assessments for people who use the service. It was evident from these that people’s independence is promoted in the home and they are enabled to do as much as possible for themselves, for example, in relation to their personal care or accessing the community. We know from previous inspections of the home and discussion with people at this inspection that individuals have been empowered to learn public transport routes to be able to get to work themselves and one service user has been able to achieve their goal of learning to drive and is in the process of purchasing a car. A care professional we spoke with told us that the home had been proactive in risk assessing a service user’s bedroom environment to ensure that it was safe for them given their specific health needs and minimised the risk to them if they fell. We have recommended to the home that the risk assessment is extended to include the risk of them falling on a hard floor in another area of the home or out in the community to ensure that it is fully comprehensive. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 14 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 have opportunities to engage in positive and fulfilling activities that are meaningful to them and promote their social and emotional well-being. EVIDENCE: Observation of people in their home, discussion with them and inspection of their records indicated that people are offered plentiful opportunities to access their local community and pursue personal interests. We observed that people have individualised programmes which include them attending college, work placements, playing sports and attending fitness classes. The Home Manager told us that they are making links with initiatives in the local community to promote people’s integration. The home demonstrates a pro-active approach in this area which deserves commendation. We also saw evidence of people Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 15 being fully involved in activities within the home, for example, assisting with cooking and other domestic tasks. We noted that some people who use the service enjoy a very active lifestyle while others prefer a quieter pace of life – this has been respected in the opportunities available to them. One person who uses the service holds a position of responsibility at a local advocacy organisation which he was keen to talk about – the home was seen to support him with his involvement. The records we looked at showed that people have been supported on trips to local towns and to places of interest such as New Forest, Marwell Zoo and London. We were told that one individual who is passionate about aeroplanes will be having a flying lesson for his birthday and in doing so will fulfil a personal goal. A member of staff told us in a survey that they felt the home does well at providing an individualised activity programme for the people who live there. A care manager commented that the service ‘always supports individuals to live the life they choose wherever possible’. We looked at the home’s rota which shows that there is usually one care worker on duty at any one time. The Home Manager told us that staffing levels do not interfere with people having their individual needs met and the home would employ additional staff in the event of people expressing a wish to attend a specific, planned event. We have explored this further in the ‘Staffing’ section of this report and made a recommendation that staffing levels are kept under review as the current staffing ratio may restrict people in making spontaneous decisions about things they want to do. Discussion with people who use the service indicated that their rights are respected in the home and they are encouraged to have their say. We observed that people have access to all communal areas of the home and the atmosphere is very much of an ordinary home shared by four people of a similar age. People we met spoke about the contact they have with their families and relatives told us in surveys that they have regular contact with them. We observed individuals being involved in preparing the evening meal in the home. The home is using pictures to show what is on the menu for that day and minutes of residents’ meetings indicated that people have a say in menu planning. Meals eaten by people who use the service are recorded and records we looked at were generally in sufficient detail. We observed that one person prefers to wake up later than the others and this is respected with him being enabled to eat breakfast in his own time. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 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’s independence is promoted in their personal care. However, care plans contain inconsistent information about people’s health care requirements which means that care workers may not always have the right information to meet their needs. Medication procedures are in place and generally work well but some areas of training need improvement to evidence that staff are fully competent and can meet identified health care needs. EVIDENCE: We observed during the inspection that the home promotes people’s rights to have choice about the time they wish to get up and eat breakfast. Out of three relatives who responded to our survey two indicated that the home always gives the support to their relative that they would expect, the other indicating that this was usually the case. One relative told us; ‘they exceed my expectations’. Care plans we looked at showed that people’s independence is promoted with regards to their personal care. For example, one person is keen Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 17 to maintain their autonomy as far as possible with shaving. A risk assessment has been undertaken with regards to this and measures put in place to promote the individual’s independence while ensuring they remain safe. The records we looked at in relation to people’s health care showed that there was active involvement from health care professionals with regards to their physical, mental and emotional health. For example, one person who has recently experienced a bereavement has been supported to attend their doctor for a referral to counselling. Another person has involvement from a Community Nurse with regards to their epilepsy and in relation to their diabetes. A doctor who has contact with the home indicated that the home communicates clearly and works in partnership with them. He indicated that he was satisfied with the overall care provided to people who use the service. A health care professional we spoke to told us that the home ‘seems to work well as a unit’. However, one individual whose records we looked at had missed their six-monthly check-up with a dentist where an appointment had not been made for them by the home. Also, individuals’ needs with regards to foot and nail care were not specified in care plans. The Home Manager told us that he takes responsibility for cutting people’s nails as appropriate. The need for possible professional input with regards to chiropody was not covered in the plans we looked at. This was raised with the Registered Manager who has informed us that prompt action has been taken to review people’s needs with regards to this and ensure that records reflect this. We looked at a sample of records for evidence that people’s health care needs are clearly documented. There was some good written information on one person’s file indicating the signs that their health may be deteriorating. This is important so that care workers can recognise the signs and respond appropriately. A specific epilepsy care plan had also been drawn up for the person with a Community Nurse giving the clear instruction that staff ‘must dial 999 immediately. Do not wait.’ However, in another part of the file it was stated ‘If X has a seizure dial 999 after three minutes’. The Home Manager told us that this was ‘old information’ which had since been reviewed. The home was told to ensure that ‘old information’ is archived so that it does not conflict with new information. For a person with diabetes we found further conflicting information. Their file contained the Apple House procedure for diabetes which advised staff to check the persons blood sugar levels if they are concerned and to give ‘fast-acting carbohydrates’ such as lucozade or sugar. However, another printed sheet in the file (the origin of which was not identified) stated ‘If a diabetic service user displays symptoms of low / high blood sugar call their doctor immediately’. The same individual’s support plan indicated ‘When I am unwell I need help cutting up foods as there is a risk I could choke’. However a report from a Speech and Language Therapist written in 2007 also on file recommended that food is always chopped up into bite-sized pieces to minimise the risk of Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 18 choking. The Home Manager told us that this assessment had been undertaken when the person was unwell and needed his food to be cut up. He stated that the service user was well at present and did not need this intervention. The manager was advised to contact the Speech and Language Therapist to clarify her recommendation. We brought these discrepancies to the attention of the Home Manager and Responsible Individual and advised them that urgent action needed to be taken to ensure the documentation is always consistent and provides clear instructions to care workers. We also told them that any care plan about a specific health care need must be directly related to the individual it concerns rather than providing general advice, for example, on diabetes. We also advised the home to ensure that any care plan relating to specific health care need such as diabetes is shown to a professional with expertise in this area so that it can be endorsed as giving advice based on best practice. Following the inspection we were sent a revised care plan on supporting the person with their diabetes although we do not know if this has been drawn up in consultation with relevant professionals. We looked at a sample of seizure monitoring charts. The Home Manager told us that it was usually him who completed the monitoring record which would then be sent to the Community Nurse. However, when we looked at the rota it was evident that he would not always have been on duty at the time of each seizure occurring. Discussion with the Home Manager indicated that he had taken information about the person’s seizure from incident reports written by staff on duty and transferred it to the monitoring record. We were concerned that this means the monitoring records are not always a contemporaneous record made by the person witnessing the seizure. The Home Manager told us that there was always enough information on incident reports to be able to complete the monitoring charts fully. However, this is not good practice and should be reviewed. A health care professional told us that the home was always prompt at faxing through information about the person’s seizures. The Home Manager told us that one person who uses the service requires support with having their blood sugar levels checked ‘usually once a week or if concerned’. The home’s Annual Quality Assurance Assessment states that ‘All of our staff have had training in how to check sugar levels’. At the inspection, we were told by the Home Manager that three care workers have been trained in-house to undertake blood glucose monitoring checks with a service user who has diabetes. Training is provided in-house by using a video issued by the manufacturer of the equipment. Arrangements for the person’s blood sugar levels to be checked in the event of a member of staff who is not trained to do so being on duty were not clear. People’s medication is supplied by a local pharmacy who also supplies printed Medication Administration Record (MAR) charts for use in the home. The Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 19 majority of medication was seen to be supplied in monitored dosage systems. Medication is stored in a lockable, wooden cupboard in the home’s kitchen. We checked a sample of medication against the MAR chart. This suggested that all medication had been given as prescribed and signed for. An audit trail was in place with medication being checked at each shift handover to ensure that it has been given appropriately. The Home Manager told us that this system is working well. A homely remedies chart was in place and has been signed by a general practitioner. The home’s Annual Quality Assurance Assessment tells us that ‘all staff have medication training and have completed a (pharmacy) in-house medication course’. We looked at a sample of training records for four care workers. All showed that they had attended medication training as part of their induction programme with the agency. For some staff there was evidence that they have gone on to complete a workbook provided by the pharmacy while working at the home. In one person’s records we looked at, their competence to administer medication had been signed off by the Home Manager following completion of the workbook. There was no record to show that they had been observed using the system and administering medication before being deemed competent. The Home Manager confirmed that he takes responsibility for supporting people through their in-house training in medication. The Home Manager does not hold any specific qualifications in training or assessing staff in the administration of medication. The Responsible Individual for the service told us that this was something that could be looked into to ensure that assessment processes are fully robust. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 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. Procedures are in place in the home to respond to concerns and ensure people are protected from harm. EVIDENCE: On our visit to Apple House the home’s complaints procedure was on display in the hallway. This gives contact numbers for the Responsible Individual, the Registered Manager and the Home Manager so that people who may wish to raise concerns can do so directly with the people in charge of the home. The procedure also gives contact details for the Commission. We looked at the complaints record in the home. One complaint had been recorded which was from a service user. Discussion with the Responsible Individual indicated that this had been responded to appropriately and the person concerned had been satisfied with the response. The Commission has not received any complaints or concerns about the service. All four people who use the service told us in surveys that they knew how to make a complaint and felt that their carers listened to them and acted on what they say. All three relatives responding to our survey told us that they knew how to make a complaint if they needed to. One relative told us that any issues they raised were usually responded to appropriately by the home, the other two indicating that this was always the case; ‘Although I have had no cause to complain they have always answered any questions and given a Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 21 quick, pragmatic response’. Both care workers who responded to the survey said they knew what to do if a service user or their relative had concerns. A care manager told us that the service had always responded appropriately to issues raised. We noted a flowchart on the kitchen wall depicting the local safeguarding adults procedure. Inspection of a sample of care workers’ training records indicated that they had all received training in abuse awareness. There have been no safeguarding referrals or investigations in connection with the home in the past twelve months. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 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 provides a bright, homely and clean environment for people to live in. EVIDENCE: Apple House is a semi-detached property situated along an ordinary residential street in Bournemouth. The ground floor comprises a lounge, dining area and kitchen with access to the rear garden. There is one bedroom and a separate toilet facility also on the ground floor. The first floor is accessed up a flight of stairs and comprises three further bedrooms, one of which has an en-suite bathroom. There is a shower room and toilet for shared use on the first floor. Since the last inspection of the service the home has been redecorated. It is bright and airy and people we spoke with told us that they liked the décor. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 23 Two people were keen to show us their bedrooms and told us they were happy with their rooms which were personalised to their individual tastes. We were advised by the Responsible Individual that there is an ongoing programme of refurbishment in the home to address general wear-and-tear of the facilities and to ensure that the premises remain in a good state of repair. The home has told us in their Annual Quality Assurance Assessment that they have a policy on preventing infection and communicable disease. The home presented as clean on our visits and people who use the service told us that the home was always fresh and clean. People who use the service are supported to help with domestic chores. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 24 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. Staffing arrangements in the home do not always promote best outcomes for people who use the service in terms of consistency and continuity of care. EVIDENCE: At the last inspection of the service we made a requirement for the home to employ enough permanent staff to ensure service users receive continuity of care. The provider has told us in their Annual Quality Assurance Assessment that, for the second half of the year, there has been a ‘regular staff team’ at the home. Discussion with the Responsible Individual for the service at the inspection indicated that one member of staff in the home, the Home Manager, is currently employed by Apple House Limited. We were told that following a recent recruitment campaign a second permanent member of staff had also been appointed as a Senior Support Worker. The remaining team of care Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 25 workers are employed via an agency. The Responsible Individual told us that they are working closely with the agency to ensure that the same agency workers are supplied to the home in order to promote consistency for the people who live there. We looked at the home’s rota for the period between 6th July and 2nd August for evidence of this. In this four week period there were a total of 56 12-hour shifts to be covered. 28 out of the 56 shifts (a total of 50 ) were covered by the Home Manager who is permanently employed by Apple House and the Senior Support Worker who had also recently been appointed. The remaining 50 of shifts were covered by a total of 9 other workers from the agency. We discussed these staffing arrangements with the Responsible Individual as we remain concerned that the regular use of agency workers does not promote the consistency needed by the four people who use the service. Furthermore, care workers work alone in the home which further increases the level of risk. We saw systems in place to promote communication in the home, including communication books and memo files. People who work in the home told us in surveys that communication was good and they have enough information provided to them to meet people’s needs. However, the number of care workers providing care in this four week period, most of whom are working fewer than four shifts during this time, means that some care workers may not have the ongoing knowledge of people’s needs that is desirable to provide continuity of care. The Responsible Individual told us that they were liaising with the agency about the implementation of ‘commitment contracts’ for agency workers whereby workers will be asked to make a commitment to work a specific number of hours in the home. It is anticipated that this will increase consistency for the people who live in the home. Following the inspection we spoke with the Registered Manager, who is also a Director of the company, who confirmed this and also said that they were giving serious consideration to employing their own team of staff. We are repeating the requirement for the home to demonstrate to us that they are employing enough permanent staff to promote consistency for people who use the service. The home’s rota shows that there is one member of staff on a shift for four service users. The Home Manager told us that this did not interfere with the provision of person-centred care with regards to activities as two people are able to access the community independently. However, we noted an entry in a daily record which said; ‘We’ve had to stay in today due to X’s poor health’ and we also noted from care plans that one individual prefers to go to bed early in the evenings. As there is only one member of staff on duty this potentially restricts people’s freedom to go out spontaneously unless they are able to do so independently. The Home Manager told us that when there had been specific events that residents wanted to attend additional staffing had been arranged to enable them to happen. The two care workers who responded to the survey also indicated that there were always enough staff to meet people’s Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 26 needs. However, a recommendation has been made that the home continues to keep staffing levels under review to ensure that individuals’ needs and preferences can be fully met at all times. The Responsible Individual told us that all care workers attend a full induction programme which is facilitated by the agency before they are allowed to commence work in the home. We looked at a sample of profiles for four agency workers. These provided evidence that people had checks undertaken with the Criminal Records Bureau, some information about their work experience and a list of training courses they had attended as well as a photograph. However, some recording of training needed to be clearer to indicate where and when each training course took place so that the registered provider can be confident that all staff are trained to a consistent standard. The Responsible Individual agreed to take prompt action to ensure that this is addressed. We have given the Responsible Individual a copy of Schedule 2 of the Regulations so that they are fully aware of what is expected from them in relation to the employment of care workers. Within the sample of staff training records examined, it was found that four care workers had received training on epilepsy to support living people at the home. A care worker told us in a survey that the induction programme they had attended had covered everything they needed to know to do the job when they started. They also told us ‘I had to come in to meet the residents and have an hour’s thorough induction before I could start work at Apple House’. Since the last key inspection a ‘first day induction’ framework has been put in place in the home for new care workers. This covers medication, money, fire safety, emergency procedures, cleaning routines, record-keeping, service user records and policies and procedures. Records we looked at showed that each care worker had completed this orientation to Apple House. However, there was no evidence that all care workers had been given an opportunity to work alongside an experienced member of staff before starting to lone-work in the home. The Home Manager indicated that this sometimes happened but was not consistent practice. This must be addressed to ensure that people who use the service have had the opportunity to get to know their care workers before they start work and care workers have the opportunity to learn about people’s needs and familiarise themselves with the home’s routines. Care workers responding to the survey told us that they felt well-supported in their role through individual supervision and team meetings and felt confident of their ability to meet people’s needs. Care workers also told us that there is an oncall system they can use if they need advice or support and they can also contact staff on duty at the provider’s other home if they require assistance. The home has told us in their Annual Quality Assurance Assessment that one permanent care worker in the home has a National Vocational Qualification (NVQ) at Level 2 or above and three agency workers also have a National Vocational Qualification. All three relatives who responded to the survey indicated that, in their opinion, care workers usually had the right skills and Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 27 experience to look after people properly. One relative, however, added ‘I have my doubts about agency staff employed having the training needed’. A care manager who responded to our survey indicated that staff always had the right skills and experience to meet people’s needs. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 28 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 home promotes service user involvement in decision-making and ensures that health and safety checks are carried out to safeguard people’s welfare in the home. The registered provider has stated their commitment to continuous improvement but has not been able to demonstrate this sufficiently in relation to two requirements made at the last inspection that remain unmet. EVIDENCE: The Responsible Individual for the home is Mrs Romaine Lawson who is also one of the Directors of Apple House Limited. The Registered Manager of the home is Mrs Jane Montrose who is also a Director of the company. Mrs Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 29 Montrose and Mrs Lawson have appointed a ‘Home Manager’. The home’s Annual Quality Assurance Assessment says that the Registered Manager ‘shapes the policy and procedure in the home and makes sure that the home is running smoothly’ while the Home Manager ‘implements these procedures and manages the day-to-day running of the home’. We are told that the Home Manager’s responsibilities include providing support and supervision to staff, maintaining a safe working environment in the home as well as managing the house budget. Mrs Lawson told us that they intend to support the Home Manager in applying to the Commission for registration as manager. Discussion with them indicated that in terms of daily presence in the home the Home Manager is based at the home more frequently than the Registered Manager. Given the information obtained from the Annual Quality Assurance Assessment and the inspection it was agreed that it would be appropriate for this to be formalised through the registration process and for the Home Manager to apply for registration. The Responsible Individual acknowledged that, as the Home Manager works twelve hour shifts at the present time and has many responsibilities for providing ‘hands-on’ care to service users, this would need to be reviewed in the event of his application to register being successful. The registered provider has taken appropriate action to meet most of the seven requirements we made at the last inspection. However, we are concerned that we need to repeat two requirements from the last inspection where the regulations have not been fully met. The provider has told us that they are committed to improving the service and ensuring that they meet the Regulations and National Minimum Standards. We recommend that the provider undertaks regular quality audits of records and processes in the home to ensure that the regulations are being met. This will enable them to take prompt action to address any shortfalls they identify. Mrs Montrose and Mrs Lawson communicate well with the Commission and in the past twelve months have notified us of events in the care home. They also sent us their Annual Quality Assurance Assessment when we asked for it. The home has a quality assurance process in place and we were given a copy of the outcomes for the 2008 survey they have undertaken. Mrs Lawson told us that this year they decided to focus on outcomes for people who use the service with regards to their activities, independent living skills and outcomes in relation to privacy and dignity. Mrs Lawson advised us that it is their intention to ensure that the next quality assurance process incorporates the views of other people who have contact with the service. An annual development plan has also been drawn up for this year. Talking with people who live in the home it was clear that their views and wishes are central to the development of the service. People who use the service told us that they have been actively involved in interviewing Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 30 prospective staff, are being supported to achieve their goals and their views are taken into account on a daily basis by the management of the home. We looked at a sample of health and safety records in the home. We saw a fire risk assessment in place that had been completed by an external agency in September 2007. Monthly practice evacuations had taken place in the home and had been documented. Records to evidence testing of portable electrical appliances were also in place. The home has been proactive in establishing a system to check their water supply for legionella and there were records in place to evidence testing of water temperatures to ensure they are within a safe range. It is, however, suggested that they document the outlet that is checked on each occasion to ensure that all outlets are tested at regular intervals. We also saw that regular checks of refrigerator and freezer temperatures are carried out to ensure that food is being stored appropriately and that people are not at risk of infection in this respect. The home has an emergency plan which includes information about the action to be taken in the event of a utilities disruption, heatwave, outbreak of infection or extreme staff shortage. The telephone number of the Commission needs to be updated in this document to show that of the Regional Contact Team. Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 31 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 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 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 2 X 3 X X 3 X Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 32 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. This requirement is repeated from the last inspection of the service as the previous timescale of 01/12/07 has not been met. 2. YA19 18(1)(c) Where the need for specific 30/11/08 health care procedures is indicated in people’s care plans, for example, blood sugar checks, all care workers must receive the necessary training to meet this identified need. The registered person must ensure that there are enough permanent staff employed at the home to ensure service users receive continuity of care. This requirement is repeated from the last inspection of the service as the timescale of 01/10/07 has not been Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 33 Timescale for action 30/11/08 3. YA33 18(1)(b) 31/12/08 met. 4. YA35 18(2) The registered persons must ensure that a member of staff who is appropriately qualified and experienced is appointed to supervise new workers in the home. People who work in the home must receive training in epilepsy to be able to understand and meet the care needs of people who use the service. 31/10/08 5. YA35 18(1)(c) 30/11/08 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 Care plans should be reviewed to ensure that they contain consistent, clear instructions about people’s needs and how they are to be met. Information that is no longer relevant to the service user should be archived to ensure that information on file is accurate and gives care workers the right information to meet people’s needs. The provider should audit support files on a regular basis to ensure that they are maintained in good order. 2. YA9 The risk assessment for one person who is at risk of falls should be extended to include the risk of them falling on a hard surface in the home or out in the community to ensure that risks are minimised. Epileptic seizure monitoring records should be completed by the care worker who witnesses the seizure so that they are a contemporaneous record of the event. The registered persons should ensure that the delivery of Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 34 3. YA19 care is always based on best practice and the advice of health care professionals and that this is incorporated into people’s support plans. 4. YA20 The registered persons should be clear about the competencies needed by all staff in relation to administering medication at Apple House and develop an internal training and assessment programme to ensure that they meet these competencies before they are required to administer medication. Assessment of people’s competence should include observation and assessment of their practice. Assessment of care workers’ competence in administering medication should be done by someone who is trained and qualified to do so. 5. YA32 All care workers at the home should have achieved, or be working towards an NVQ in Care of at least Level 2 standard. Staffing levels should be reviewed to ensure that there is always enough flexibility to meet individuals’ needs and to encourage spontaneity. The registered persons should ensure that the profiles of agency workers specify where and when their training was obtained so that they can make a judgement whether it is adequate to meet the needs of people who use the service. The registered persons should ensure that regular audits of records and procedures in the home take place so that they identify for themselves any shortfalls and put systems in place to rectify these. 6. YA33 7. YA34 8. YA37 Apple House DS0000063160.V365977.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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