Inspection on 04/10/05 for Applemead

This inspection was carried out on 4th October 2005.

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

Other inspections for this house

Applemead 15/09/09

Applemead 05/07/07

Applemead 11/08/06

Applemead 19/04/05

Applemead 23/09/04

Applemead 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Applemead Station Road Whimple Exeter Devon EX5 2QH Lead Inspector Vivien Stephens Unannounced Inspection 4th October 2005 2 pm Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Applemead Address Station Road Whimple Exeter Devon EX5 2QH 01404 823332 01404 823382 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) Sense Mr Jason Leonard Wright Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: Applemead provides support and personal care to people with a learning disability and sensory impairments. The property is a six bedroomed detached house located in the village of Whimple. The home is a few minutes walk away from the village and is less than 2 minutes away from the railway station. It is approximately 9 miles from the city of Exeter. Bedrooms are situated on the first floor of the house along with two bathrooms and integral toilets. The downstairs comprises of an office, kitchen, lounge / dining area, conservatory, a quiet soft padded “snoozelem” room, a shower room with toilet and laundry room. There is a sensory garden to the rear of the property. Some adaptations have been made to meet the needs of each deaf / blind person. The home is operated by the organisation SENSE, who specialise in sensory impairments. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 2 pm and finished at 5.30 pm. During the afternoon 4 residents were at home, one person was at college and one person was on holiday. The Acting Manager, Angela Martin was on duty along with five members of staff. There were a further 3 staff on duty accompanying the 2 residents who were away from the home. A number of the residents living at Applemead have limited verbal communication skills therefore were unable to contribute fully to the inspection process. Therefore the focus of the inspection was to observe interactions between residents and staff, and to talk to staff about life at the home and about how they help residents to lead fulfilling and happy lives. Since the last inspection the manager, Jason Wright, has left and Angela Martin has been appointed as Acting Manager until such time as a new Manager is appointed. What the service does well: The level of health and personal care needs covered in the care plans is excellent. Residents are encouraged to make choices and decisions about their daily lives, and staff have given careful consideration to any potential risks and how these can be minimised. The staff provide sensitive and appropriate support to the residents. The home provides an excellent range of opportunities for residents to take part in social and leisure opportunities both in the home and in the local community. Families and friends are encouraged to visit and participate in the daily life of the home, including decisions about how the home is run. Residents receive a wholesome diet that suits their individual needs. Health care needs have been fully met. Sense have robust procedures in place for the investigation and prevention of abuse. The property has generally been well maintained, and is bright, clean, spacious and comfortable. One bathroom is due to be refurbished in the near future. Staffing levels are appropriate to meet the needs of the residents. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 6 The health and safety of residents and staff is protected through staff training and robust policies and procedures. What has improved since the last inspection? What they could do better: 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. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards 1 and 2 were covered at the last inspection and therefore none of the standards in this section were covered in full at this inspection. At the last inspection a recommendation was made that the home should clarify the items that residents will be expected to pay for. The recommendation specifically referred to transport costs. Since the last inspection no action has been taken to amend the Statement of Purpose/Service User Guide or Terms and Conditions of Occupancy to explain the homes policy on transport costs. The home currently charges each resident a proportion of their Mobility Allowance towards the cost of running the vehicles provided for residents’ use. This is not specified in any documents provided to prospective or current residents and their families or representatives. This item is therefore recommended once more. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The level of health and personal care needs covered in the care plans is excellent. However, there may be problems finding important information quickly due to lack of indexes and varying layouts of the plans and therefore this should be reconsidered. Residents are encouraged to make choices and decisions about their daily lives, and staff have given careful consideration to any potential risks and how these can be minimised. EVIDENCE: During the inspection 2 care plans were read. These files covered all areas of care needs in great detail and included health needs and risk assessments. The files have been separated into sections using file dividers. The care plans cover many pages and sections. Staff talked about whether they felt it is easy to find relevant information quickly. The layout of the plans has been altered in the last year and on the whole staff said they now know where to find information quickly. However, some staff said that the lack of index, and the differing layout of some of the plans does cause some difficulties and they felt that the previous care plans were easier to follow. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 10 Full care plan reviews are carried out annually involving the residents, relatives, care managers and other relevant persons. The home also reviews the plans throughout the year to ensure it is constantly updated. Staff make written reports at the end of each shift setting out the activities each resident has participated in and any issues arising. The plans contained clear information about the health needs of each resident and the advice and treatment provided by all relevant health care professionals including physiotherapy, audiology, dietician, ophthalmology and GPs. The care plans set out in detail the way each resident wants to be assisted throughout the day. Throughout the inspection staff talked about how they help the residents to make choices about their lives, including choice of activities, clothing, times of getting up and going to bed, food, holidays and decoration and furnishing of their bedrooms. Residents were seen helping with cooking tasks and staff were observed consulting with the residents to check the residents’ wishes and preferences. The plans include detailed risk assessments on all regular activities. These demonstrated clearly how the home supports residents to be as independent as possible while at the same time minimising any potential risks. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 17 The home provides an excellent range of opportunities for residents to take part in social and leisure opportunities both in the home and in the local community. Families and friends are encouraged to visit and participate in the daily life of the home, including decisions about how the home is run. Residents’ dietary needs have been met. EVIDENCE: Residents’ educational and leisure needs and preferences have been identified through the care planning system and are reviewed regularly. The home has a plan of the regular weekly activities for each resident. The plan shows a range of activities including sessions at the Doyle Centre, Exmouth, courses at Bicton College and Taunton College, horse riding, swimming, cooking, arts and crafts, gardening club, massage and walking. On the ground floor there is a wellequipped ‘Snoozelem’ type sensory room. The home has recently employed a Practice Development Worker to review the educational, employment and leisure needs of each resident. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 12 At the time of this inspection one resident was at Bicton College and one was on holiday. During the afternoon one resident went out for a walk and another helped with the cooking. Staff talked about some of the things the residents enjoy doing including growing plants in the garden, barbeques, going out for walks and arts and crafts. Colourful arts and crafts were displayed around the home. Each resident has at least one holiday a year. This year holidays have been arranged for such destinations as Dawlish, Cornwall and Malta. The home encourages families to be fully involved in the home. Families have been invited to attend a meeting to share their views and ideas about the home. Residents are supported to keep in regular contact with families and friends. Careful attention has been paid to the individual dietary needs of each resident. The advice of a dietician has been sought. Weight is monitored where necessary. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 Residents receive sensitive and appropriate support from the staff team. Health care needs have been fully met. EVIDENCE: The care plans set out how each resident wants to be assisted and cared for by the staff. Individual preferences about getting up/going to bed, choice of clothes, and assistance with personal care and hygiene have been clearly documented. Each resident has a named keyworker. At the last inspection a requirement was made for grab rails to be provided in the bathrooms to ensure residents are able to get in and out of the bath safely. However, builders have been unable to install grab rails due to the structure of the walls. There are plans to install a new bathroom in the near future and it may be possible to install suitable mobility adaptations at the same time. In addition it is recommended that further advice is sought from and Occupational Therapist on the most suitable equipment according to the individual needs of the residents. There was good evidence that healthcare needs have been fully met, both in the care plans and in discussion with Angela Martin and the staff. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Sense have robust procedures in place for the investigation and prevention of abuse. EVIDENCE: Since the last inspection two complaints have been received. These have been investigated by Sense and the complaints have not been upheld. The home has very thorough policies and procedures covering all aspects of concerns, complaints and suspected abuse. There is a ‘whistle blowing’ policy, and staff are given various opportunities to speak out to someone if they have any concerns. Regular supervision sessions, staff meetings, and visits by area managers provide staff with opportunities to voice their opinions or concerns. Complaints procedures are displayed in the hallway, on the office door, and on the wall of the laundry. These clearly set out the procedures for making complaints or raising concerns. Staff have received training and instruction on the protection of vulnerable adults. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 The property has generally been well maintained, and is bright, clean, spacious and comfortable. The exterior paintwork is beginning to look worn and in need of attention. The organisation has provided adequate funding for major updating projects including the kitchen and bathroom refurbishment. Each bedroom is bright, comfortable and personalised. All areas were clean, hygienic and odour-free. EVIDENCE: Applemead is situated in a residential area close to local facilities including the local railway station. The property is detached with a good-sized enclosed rear garden. On the ground floor there is a large recently re-fitted kitchen, office, lounge/diner, conservatory, laundry, shower room and ‘snoozelum’. On the first floor there are six bedrooms for residents, a sleeping-in room for staff, and two bathrooms. The decoration of the home is good overall, although the outside of the house is beginning to show signs of deterioration especially the guttering and fascia boards. The home is comfortably furnished. The kitchen has recently been re-furbished and is now bright, modern and well equipped. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 16 Each resident has a single bedroom of reasonable size. The bedrooms have been individually decorated and furnished according to the tastes and preferences of each resident and appear comfortable and homely. Funding has recently been agreed to replace one of the first floor bathrooms with a new ‘sensory’ bathroom with level access shower, whirlpool bath and hot-air drier. This is likely to be installed in the New Year. At the last inspection a requirement was made that grab rails must be installed in the bathrooms to assist residents to get in and out of the bath safely. A builder has visited to carry out the work but was unable to complete the task due to the structure of the walls. In view of the proposed installation of new bathroom fixtures it is recommended that suitable mobility aids are installed at the same time, along with any structural work necessary. It is also recommended that the home seeks further professional advice from either and occupational therapist or physiotherapist on the most suitable mobility aids for each bathroom. All areas of the home were found to be clean and free from any offensive odours. The laundry is well equipped and in good working order. Residents are encouraged to help with the laundering of their clothes where possible. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Staffing levels are appropriate to meet the needs of the residents. Staff have received a satisfactory level of training with the exception of the LDAF framework. There are a number of staff vacancies and therefore recruitment must be given a high priority. EVIDENCE: At the time of this inspection Angela Martin, Acting Manager was on duty. There was also one Practice Development Worker, two permanent Support Workers, and one agency staff working in the home. Four residents were at home. In addition there were three Support Workers on duty and working with the two residents who were away from the home. This gives a ratio of staff to residents of at least one-to-one and in some cases two-to-one. Staff talked about the range of training they have received. They have received training on all mandatory health and safety related subjects including infection control. They have had training on the protection of vulnerable adults. All staff have either gained, are in the process of gaining, or are about to start NVQ level 3. No staff have undertaken the LDAF award framework yet. There were a number of staff vacancies at the time of this inspection including the manager’s post, 2 senior support workers, 2 general support workers and Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 18 one waking night staff. The home is currently using a high number of agency staff to fill these vacancies. Angela Martin said that recruitment has been given a high priority. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 The home is committed to ensuring residents receive a good quality of care, facilities and services. The health and safety of residents and staff is protected through staff training and robust policies and procedures. EVIDENCE: The home has a range of quality assurance methods in place including regular staff supervision, staff meetings and ‘regulation 26’ visits by a representative of the Sense senior management team. Relatives are encouraged to participate in the running of the home and to air their views through a regular ‘family forum’. Minutes of the core team meetings are also forwarded to families. Staff have received training in all mandatory health and safety related topics. Policies and procedures are in place on all health and safety topics. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 X 17 Standard No 31 32 33 34 35 36 Score X 4 3 2 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Applemead Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000021878.V249718.R01.S.doc Version 5.0 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23(2) (b and n) Requirement The registered person must ensure the premises are of sound construction and kept in a good state of repair. Suitable adaptation must be made (This refers to the provision of grab rails or suitable equipment in the bathrooms to assist residents to get in and out of the bath safely) Timescale for action 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations Details of the items residents will be expected to pay for should be further clarified within the contracts, statement of purpose or terms and conditions of occupancy. The home should ensure that staff, residents and/or their representatives know exactly what services are covered within the fees and what items are considered to be ‘extras’ that the residents will be expected to pay for. (This refers to transport costs). Some areas of the exterior paintwork are in need of repainting. DS0000021878.V249718.R01.S.doc Version 5.0 Page 22 2 YA24 Applemead 3 4 YA34 YA35 Permanent new staff should be recruited in order to address the large proportion of staff vacancies and minimise the use of agency staff. Staff should receive Learning Disability Award Framework accredited training. Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Applemead DS0000021878.V249718.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!