Inspection on 16/10/07 for Applelea

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Applelea 19/03/07

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Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

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Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 Applelea The Harrow Way Basingstoke Hampshire RG22 4BB Lead Inspector Michael Gough Unannounced Inspection 16th October 2007 10:30 Applelea DS0000068254.V347437.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 Applelea DS0000068254.V347437.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. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applelea Address The Harrow Way Basingstoke Hampshire RG22 4BB 01256 364044 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) Liaise Loddon Ltd Amanda Kim Rayner Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users may be accommodated from the age of 16 years. Date of last inspection 19th March 2007 Brief Description of the Service: Applelea is registered to provide accommodation and personal care for four adults (18-64 years, both genders) with severe learning disabilities and complex restrictive behaviours, including life threatening self-injury usually associated with autism. It is designed for individuals who require 1:1 support to access the community, and who may have additional needs associated with epilepsy and sensory impairment. The registered provider is Liaise Loddon Ltd., which operates a number of other homes for people with learning disabilities and challenging behaviour usually associated with autism. The property comprises a detached two-storey house, on Harrow Way just outside Basingstoke centre, with all the community and transport links that implies, including a main line train station and bus routes. The home also has its own transport. This home first registered in October 2006 and is a two-storey detached building, set back from the Harrow way. It comprises four single bedrooms one on the ground floor, and the other three on the first floor. All four bedrooms exceed the National Minimum spatial Standard, and three of them have full en suite facilities. The fourth has exclusive use of an adjacent bathroom / WC facility. The home also has a communal lounge and kitchen/dining room, another WC/bathroom and laundry. There is space for up to eight vehicles on site and there is unrestricted kerbside parking on a nearby lay-by. The current fees for the service at the time of the visit range from £2,800 £3,500 per week. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the evaluation of the quality of the service provided at Applelea and takes into account the accumulated evidence of the activity at the home since the last inspection, which was carried out on the 19 March 2007. The inspection took into account the homes Annual Quality Assurance Assessment (AQAA); and comment cards received from 2 relatives and 4 members of staff. Included in the inspection was an unannounced site visit to the home, which took place on the 16 October 2007 Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and service users. It was not possible to gain the views of people living at the home due to the nature of their learning disability, however the inspector had the opportunity to speak with 4 members of staff and by speaking with the homes manager, who assisted the inspector throughout the visit. The home is registered to provide support for 4 service users who have a learning disability and at the time of the inspection the home was full. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements or recommendations made as a result of this visit, however some other points, which need to be addressed to help improve the Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 6 service provided for service users are contained within the main body of the report, general observations were: The head office for the organisation monitors service users bank accounts and the manager of the home holds bankcards for each service user to enable her to draw out money on service users behalf. This is not an ideal solution and could potentially put both the homes manager and service users at risk and the organisation should try to find an alternative to the current system. The laundry at the home is done by care staff that support service users to be involved as much as they are able. However there was no guidance or procedure for washing of soiled items and this was discussed with the homes manager who said that she would address this issue. The organisation has a quality assurance manager but the manager was not sure how this role worked in relation to the home and in order to provide effective quality assurance clear procedures for monitoring the quality of service provided needs to be implemented. 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. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that there will be a detailed assessment of their individual needs before they move into the home. EVIDENCE: The homes AQAA and also information gained at the site visit showed that there has been no new service users admitted to the home since the last inspection. The home has a clear admissions policy and the inspector was informed that the area director and the manager would carry out an assessment of any potential new service users needs and also obtain social service assessment before anyone moved into the home. There were assessment forms kept at the home for all service users and these form the basis of individual plans of care. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users assessed needs and personal goals are set out in their individual plan of care and service users are involved in the care planning process as much as possible. Staff at the home respect service users rights to be involved and make decisions about their day to day lives and service users are supported in this process by staff at the home and service users are supported to take responsible risks. EVIDENCE: Care plans were seen for 2 service users and these were comprehensive documents that gave staff clear information on what support was required and how and when this should be given, there was information on the service users routines in the mornings, afternoon and evenings. Service users were involved in the care planning process as much as possible and care plans were person centred. Care Plans seen reflected the aspirations and goals of service users and were written clearly and could be followed easily. In the care plans viewed there was good information on communication including verbal, body language, facial expression and signing (Makaton). There was also good clear Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 10 information for staff on how to respond to any challenging episodes. Staff members who returned comment cards and those spoken to on the day of the visit felt that care plans contained all the information they needed to offer the right level of support to service users. Daily recording took place using a recording from which is broken down into 23 hour periods and staff recorded how the service user had been throughout the day. Formal reviews take place at six monthly intervals and reviews included input from parents, staff, care managers, health care professionals and staff. Service users are involved in the review process as much as possible. Service users are encouraged and supported to make informed decisions as much as they are able. The home aims to give service users as much choice as possible and they use picture symbols, objects of reference and verbal communication to give service users choice in their day to day lives. The home takes into account cultural likes and needs. One service users is Greek and her cultural needs are catered for as much as possible. Risk assessments are in place and are contained in care plans, risks are identified and are assessed as High, Medium or Low risk and information on how to manage risks are contained within the care plan. Risk assessments are carried out before each community outing as different activities have varying degrees of risk for each service user and the risk can also depend on individual service users mood. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged and supported to be part of the local community and to be involved in appropriate activities. Service users benefit from support to maintain social contacts and daily routines at the home respect service users rights and responsibilities. Meals at the home are flexible and service users benefit from a healthy diet. EVIDENCE: None of the service users at the home attend any formal education classes or take part in any form of occupation. Staff support service users to develop independent living skills such as making drinks and snacks. The service users at the home take part in a range of different activities and these are tailored to the individual. Activities include swimming, cinema, horse riding, games, videos, community walks, trampoline, trips to pubs and cafes and shopping. The home also run an awards scheme for service users Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 12 and they receive a certificate in recognition of their work and efforts and staff said that service users respond well to these awards. The home has a visiting policy and family and friends are welcome at any time. Service users are encouraged and supported to maintain family links and staff support service users to visit their parents if appropriate. Daily routines in the home promote service users independence as much as possible and they are supported to undertake routine tasks around the home service users are involved in the day to day running of the home as much as there abilities allow. Staff were seen to treat service users with dignity and respect throughout the visit and staff were observed knocking on service users doors before entering and seeking permission for them to enter their rooms. Mail is given to service users unopened and staff support them with their mail. Service users are able to access all areas of the home and are able to choose if they wish to be alone in their rooms or be in the company of other service users and staff. The home employs a cook from 1000 – 1400 and the main meal of the day is at lunchtime. There is a four week rolling menu, which is changed seasonally and takes into account the likes and dislikes of individuals as well as nutritional needs. Each service users goes out for a meal at least once per week and this can be to the pub, restaurant, pizza or take away and it is down to the individual service user where they would like to go. Food is delivered to the home weekly and top up shopping takes place each day. Service users go shopping each week to buy their own toiletries and also go with staff to buy food. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer and service users physical, emotional and health needs are met. The homes policies and procedures with regard to medication provide protection for service users. EVIDENCE: Care plans for individual service users gave information on personal care needs and this is offered by care staff of the same gender wherever possible. There was information on what support service users required in the mornings and evenings and also information on individuals personal care skills so that staff could offer the correct type of support. The staff team are flexible round the times when service users want their personal support and there are no set routines. All of the service users have a health action plan and are all registered with a local GP surgery and all have the same GP. Arrangements are in place for dental checks, and sight checks are carried out by a visiting optician service. Service users have access to all relevant health care professionals and these are accessed through GP referral. Staff at the home monitor service users health and support service users to access appropriate healthcare professionals and to attend any appointments. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 14 The home has clear policies and procedures in place for the receipt, storage and administration of medication. All staff at the home have undertaken training in medication administration procedures and there was clear information for staff for administering when required medication. None of the service users at the home self medicates and there are no controlled drugs kept at the home, however the manager was aware of the procedures to follow if there was a need for them to be held. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 15 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by a simple, clear and accessible complaints procedure and the homes policies and procedures protect service users for any form of abuse. EVIDENCE: The home has a clear complaints procedure and this includes timescales for the complaint to be addressed and gives details of how to contact the CSCI. All service users have a copy of the complaints procedure and this is in a pictorial format, but it is unclear if service users understand the procedure to be followed. Staff spoken to were aware and said that they would support any service user to make a compliant if they wished. The home keeps clear records of any complaints made and also records responses. There have been no complaints since the last inspection. Staff receive regular training in the protection of vulnerable adults and those spoken to said that they would talk to the manager if they had any concerns, they were aware that they could go above the manager if they felt that this was appropriate and knew that social services would take the lead in any AP issues. The home keeps money on behalf of service users and there are clear procedures. Records are kept and this provides a clear audit trail. The head office for the organisation monitors service users bank accounts and the manager of the home holds bankcards for each service user to enable her to draw out money on service users behalf. Only the manager is aware of individual pin numbers and these are kept secure. The inspector discussed the Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 16 issue of the manager keeping bankcards and pin numbers for service users and pointed out the potential problems that could arise. The manager understands that this is not an ideal solution and will discuss these issues and try to find an alternative to the current system. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and service users have access to comfortable indoor and outdoor facilities. The home was clean, pleasant and hygienic and free from offensive odours and this provided a pleasant environment for service users and staff. EVIDENCE: The inspector toured the building and found that communal areas were bright and airy. The main lounge contains a large TV, hi-fi equipment and comfortable seating. There is a large open plan kitchen with a dining table with seating for four people. The lounge leads out through sliding doors to a patio area and enclosed rear garden where there is a table and seating. Service users own rooms are situated on both the ground and first floors and all were ensuite and well furnished and had been personalised for the individual service user. The home does not have a programme of routine decoration and the inspector was informed that this is carried out on a needs led basis. One of the care staff at the home carries out minor routine Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 18 maintenance and all other work is carried out by contractors who are called in as required. The home has a separate laundry room, away from areas where food is prepared, stored, cooked or eaten. There is an industrial washing machine, which is able to wash clothing at appropriate temperatures and an industrial tumble drier. Staff at the home support service users with their laundry and appropriate protective clothing is available. There was no set procedure for washing of soiled items and this was discussed with the homes manager who said that she would address this issue. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 19 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 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff employed at the home have the competencies and qualifications required to meet service users needs. Service users are protected by the home’s staff recruitment procedures and service users are supported by trained staff. EVIDENCE: The home employs a total of 14 care staff, plus the homes manager. 4 of the staff have completed NVQ2 and there is 2 staff due to start NVQ2 shortly and 1 is undertaking NVQ3. There is a minimum of 1 senior staff member plus 4 care staff on duty between 7.30am to 8pm, this ensures that service users receive a minimum of 1 to 1 support at all times. Between 8pm to 8am there are 2 staff on duty that are awake throughout the night and a sleep in staff member is available if required, There is also a senior member of staff available on call. The home has a stable staff team and recruitment records were seen for 3 staff members and all contained the required information including application form, references x 2 and CRB/POVA checks. Training records were inspected and staff at the home have completed training in Infection Control, First aid, Food Hygiene, Fire Awareness, Manual Handling, Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 20 Medication practices, Autism awareness, Managing aggressions, Learning disability information and SCIP. The home has an effective induction procedure, which covers in house procedures and also induction and foundation training in line with the “skills for care” guidelines. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 21 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home and the registered manager is experienced and competent to run the home. Service users, relatives and other interested parties are consulted about the running of the home and there are policies and procedures in place. The health safety and welfare of service users and staff are promoted and protected. EVIDENCE: The registered manager has been in post since the home was registered in October 2006 and is nearing completion of NVQ at level 4 in care and the Registered Managers Award. She has the skills and experience to effectively manage the home. Service users are consulted as much as possible on how the home is meeting its aims and objectives and this is done with staff support. Residents, relatives and care managers are included in 6 monthly care reviews and these Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 22 reviews are used to monitor how the home is meeting its aims and objectives. Regular monthly regulation 26 visits are carried out and this is another opportunity to see how the home is performing. The manager has regular conversations with relatives and staff meetings and supervision also give staff` the opportunity to express their views. The inspector was informed that the organisation has a quality assurance manager but she was not sure how this role worked in relation to the home. There are policies and procedures in place to ensure safe working practices in the home and all care staff undertake statutory training, which includes health and safety, infection control, food hygiene, first aid and manual handling. The home has a new style accident book and the fire logbook was inspected and all required testing had been carried out. Certificates were available for annual testing of equipment and services. Fire equipment was last tested in November 06, Gas equipment tested in October 2007 and Electrical wiring in October 06. Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 23 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 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 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 3 X 3 X 3 X X 3 X Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Applelea DS0000068254.V347437.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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