Inspection on 05/07/07 for Applemead

This inspection was carried out on 5th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Applemead 15/09/09

Applemead 11/08/06

Applemead 04/10/05

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 Key Unannounced Inspection 5th & 6th July 2007 2:00 Applemead DS0000021878.V339526.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 Applemead DS0000021878.V339526.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. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applemead Address Station Road Whimple Exeter Devon EX5 2QH 01404 823332 01404 823382 adrian.kennedy@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association Miss Angela Denise Martin Care Home 6 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) Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th and 15th August 2006 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 bed roomed 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. At the time of this inspection the fees ranged from £77,441 to £134,034 per annum. The home provides a copy of all inspection reports to the next of kin of each service user. A copy of each report is available in the home for anyone who wishes to read it (this is explained in the home’s Statement of Purpose). Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 1 ½ days. The first visit began at approximately 2pm. The afternoon was spent talking to the area manager who was visiting the home that day, the home manager, and most of the staff team. The majority of the staff team were at the home for training sessions and we were able to talk to the whole group at the end of the session. Further conversations took place with individual staff and smaller groups. During the first afternoon a tour of the home took place. On the second day two people living in the home were observed, the records of their care were read, and conversations took place with the staff and the manager to determine whether the level of care was appropriate for their needs. The people living at Applemead have complex needs. They have little or no communication skills and therefore rely heavily on their carers being able to communicate with them through alternative methods such as sign language, touch, or by observation and interpretation of their behaviour. The home has their own quality assurance methods, including survey forms, but these were not available to see at the time of this inspection and therefore it was agreed with the home that survey forms would be sent out by the Commission following the visit, but the results would not be available in time for this report to be published. What the service does well: The home’s procedure for assessing and sharing information with people who are thinking about moving to Applemead is careful and thorough Information about the home, and about Sense, is available in written, audio and visual formats. The home will gather information from the individual, their family and all professionals who are involved in their care to ensure they have a very clear picture about the support the person will need, and to ensure that the home has the skills and facilities to meet those needs. The process allows time for the person to visit and get to know the home and to decide if they want to live there. Detailed care plans have been drawn up for each individual living at the home. Staff have considered carefully the support each person needs and they have consulted with the person and/or their representatives and a range of specialist professionals to ensure the person receives sensitive and dignified support. The plans show that possible risks have been identified and strategies have been put in place to minimise any risks, while still enabling the person to lead their lives as they wish. The people who live at Applemead lead interesting and varied lives. The home has three vehicles, and the railway station is just a few yards from the home, and this enables people to go out and about in the community, accessing a wide range of education and leisure facilities. The staffing levels allow staff Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 6 individual time with people, enabling them to follow an individual weekly timetable of their preferred activities. There is also a good range of equipment and facilities in the home for people to enjoy various leisure interests. The facilities include a sensory room, art and craft equipment, and large screen television. The home has liaised closely with health and social care professionals to ensure that all specialist advice and treatment necessary is provided. The home has clearly set out the way that staff will support the people living at Applemead in order to ensure they receive sensitive and dignified assistance with all personal and healthcare needs. Medicines are stored and administered safely. Good procedures are in place to ensure that the people living in the home are protected from abuse. Good recruitment procedures have been followed, and staff have received thorough training on the protection of vulnerable adults. The manager and staff were able to demonstrate a clear understanding of the procedures they must follow in order to protect people form abuse. The complaints procedures are clearly displayed around the home. Applemead has been well maintained and provides a comfortable and safe home. There is a pleasant garden with sensory areas and places to sit and enjoy the garden. Everyone living at the home has a good-sized single bedroom that has been decorated and furnished according to their tastes and interests. A wide range of training has been provided to all staff. The staff were able to demonstrate a high level of skills in understanding the needs of the people living at the home. They have developed a range of communication skills and this has resulted in greater contentment and less distress shown by the people living in the home. The home is well managed. The home has maintained all records that are required by legislation to a good standard. Records showed that the home is safe. Systems are in place to gather the views of the people living at the home and/or their representatives, and to monitor all management processes. An annual quality audit report is produced by Sense. What has improved since the last inspection? Areas of the home have been redecorated in the last year including the outside of the home and the upstairs corridor. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 7 Significant improvements have been made to the level of permanent staff in the last year resulting in a committed and skilled staff team. Staff morale has improved and the staff team are now far more positive and committed. 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. The summary of this inspection report can be made available in other formats on request. Applemead DS0000021878.V339526.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 Applemead DS0000021878.V339526.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): 1, 2. 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who are considering moving into Applemead can be confident that good assessments will be carried out to ensure the home is able to meet their needs. The home will ensure that sufficient time and suitable information is given to allow the person and/or their representatives make an informed choice about the suitability of the home. EVIDENCE: The home has a comprehensive statement of purpose/service user guide that has been regularly updated, and is available in various formats, giving people good information about the home and the way it is managed. Since the last inspection no new people have moved into Applemead and therefore it was not possible to see evidence of how recent admissions have been dealt with. However, from information provided by the home prior to this inspection, and through discussions with the manager and staff there was good information about the careful process that the home would follow in the future if any new person is interested in moving in. Information provided by the home says that, before a new person moves in, they will gather and exchange information in the following ways Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 10 “Information that would be useful to obtain would be age, gender, communication, vision and hearing levels and any other sensory impairment, personal care needs, what does the person like to do, mobility, behaviours, ethnicity, identity and culture, the persons history, likes and dislikes, any medical, health, spiritual or emotional (eg; being near friends) requirements and any other special needs. This could include the need for educational provision eg; the person may want to attend a college or evening classes. All referrals are sent via the Sense national referrals officer. Applemead has a Statement of Purpose, which contains information about Applemead, the organisations aims and objectives, travel/vehicle facilities, the village of Whimple, the staff team and what training they receive. The statement of purpose is available to prospective new Individuals and others who are important to them. This is available in alternative formats, such as video and signed format. it is important that as much information as possible is gathered about a possible new person and that they receive as much information as possible about Applemead. The person will need to feel comfortable in their new environment and should be compatible with other people already living in the home. Applemead must be able to demonstrate that it can meet the needs of any new Individual. Prospective Individuals and other people who are important to them e.g.; relatives, friends, care managers and advocates are invited to visit the house and meet the staff and people living in the house.” Applemead DS0000021878.V339526.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, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People receive support from skilled staff to enable them to live their lives as they choose. Staff support people to be as independent as possible, with no unnecessary risks. EVIDENCE: During this inspection the care of two people who live at Applemead was looked at in detail. Some limited conversation took place with one person, and the care of the second person was observed, and discussion took place with a member of staff who has key responsibility for their care. The care plans and daily records for these people were read and discussed. These documents included records of medicines administered and daily care notes. The people who live at Applemead have sensory impairments and complex disabilities, and their communication skills are limited. Over the last year the staff team has become more stable with more permanent staff employed and less reliance on agency staff to fill shifts. The level of training for staff has Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 12 been high, and as a result the staff team have been able to develop their communication skills and their understanding of each person living at the home. The staff talked about how they communicate with residents through sign language, through touch, observation, and through verbal conversation. These skills and observations have been set out in the comprehensive care plans drawn up for each person, covering all areas of their care and support needs. The plans are highly detailed while at the same time easy to read and follow. The files are divided and labelled, and therefore it is easy to find specific information quickly. The information included input from various specialist health professionals. Clear and detailed guidance has been drawn up in conjunction with these professionals to guide the staff provide the right level of support to people and to help them with specific issues. Clear goals have been identified, and the guidance is set out in step-by-step stages to show how these goals can be achieved. The plans are reviewed and adjusted at least every month through core staff meetings, and through annual review meetings. The staff confirmed that staffing levels are good and enables them to spend sufficient time with each person to provide the individual support needed as set out in the care plans. Staff confirmed they have a thorough understanding of the care plans and are closely involved in discussions about how the plans should be followed. While it was not possible to communicate directly with the people living at the home to find out if they are satisfied with the way they are supported, our observations of the interactions between them and the staff indicated that the people were relaxed and happy, and the staff were highly skilled in understanding how each person wanted to be helped and supported. The staff were skilled in recognising and interpreting specific behaviours and understanding what the person wanted. In this way they were able to minimise the likelihood of a person becoming agitated or frustrated through their lack of communication skills. Through reading the care plans and discussion with staff there was good evidence to show how staff have carefully considered the rights of each person living at the home to make decisions about their lives. They were able to describe how people choose what they want to eat, where they go each day, where they want to sit, what television programmes they want to watch and what they want to do. Tactile signs around the home help people to be as independent as possible, helping them to find their way around. Each care plan includes risk assessments and detailed guidance on how to minimise or eliminate those risks identified. The risk assessments are clearly aimed at enabling people to do the things they want to do, rather than preventing them from doing things. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who live at Applemead are supported to lead interesting and varied lives. Staff have good skills to help people make choices about their lifestyle and to develop new skills. EVIDENCE: Information provided by the home before this inspection says that – “Applemead and the staff team aim to support Individuals in their preferred lifestyle. This includes ensuring that Individuals have as many opportunities opened up to them as possible, in a variety of environments. Staff are constantly supporting Individuals to source new activities and opportunities to consider participating in.” Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 14 This statement was confirmed during the inspection. Staff were seen supporting people to participate in a wide range of activities both in the home and in the community. The manager described how one person has been supported to undertake voluntary work experience, and how people have been able to attend local college courses. Each person has a weekly plan of the regular activities they want to do. There was evidence of a wide range of stimulating and fulfilling activities to help people develop new skills, including arts and crafts (the results of these sessions were displayed around the home), cooking, music, horse riding, swimming, supporting people to use the local post office, pub and shop and attend village activities, such as concerts and fetes. Various methods of transport are used, including the local rail service. Applemead has three vehicles kept on the premises for individaul use. Leisure activities at the home include massage, barbeques and nature walks. The home has a well equipped sensory room. The manager and staff talked about how they encourage people to keep in touch with friends and families either by encouraging visitors to the home or by helping people to go and see friends and families through provision of transport and accompanied by staff. The home also keeps in touch with families by telephone. The staff respect the privacy and dignity or residents in many ways. An example was seen by the provision of flashing ‘door bells’ outside each bedroom. The staff use these flashing doorbells before entering a bedroom to warn people that they are about to enter. If a person is able to use verbal communication they will wait for permission before entering. People have access to all areas of the home. Dado rails and textured items on the walls help people to find their way around. Weekly menus were displayed on the wall in the kitchen. These were varied and balanced. Individual care plans showed the level of care that has been taken to incorporate individual dietary needs into the menus. The home has sought guidance from specialist professionals on how to address individual dietary problems, and the guidance was clearly set out in the care plans. Staff talked about how they provide alternative foods if people do not like the main meal on offer, or if individuals need a specific diet. The kitchen is bright, clean and modern. People can either sit in the kitchen, in the lounge or in their bedrooms for their meals according to individual choice. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The people living at Applemead receive sensitive and dignified support with all personal and healthcare needs. Medicines are stored and administered safely. EVIDENCE: Staff talked about the ways in which they have helped to draw up detailed guidance in the care plans about how each individual wants to be supported with personal care needs. They described how they have adjusted the way they support people through their observation and knowledge of each individual. The care plans describe how people will be supported in a sensitive and dignified manner with such tasks as cleaning teeth, bathing, and going to the toilet. An example of good liaison with heath professionals was seen in one care plan. A person who needed a blood test became very distressed at the procedure, and the blood test could not be carried out. A specialist advisor helped the home draw up a plan to slowly help the person gain confidence to allow a blood test to be carried out in the future. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 16 The home has obtained support from a Learning Disability nurse in the last 12 months to provide guidance and advice on good practice issues. The staff have received a wide range of training in the last year including training and information of specific health matters such as the late manifestation of Rubella Syndrome. Aids and equipment are in place where required, including grab rails and specialist sensory equipment, enabling people to move around safely and as independently as possible. The home administers medicines using a monitored dosage system supplied by a local pharmacist that provides a safe method of administering medicines to individuals. There are five people living at the home who require regular medication. The medicines are stored securely. The cupboard was tidy and records showed that monthly stock checks are carried out. Records of medicines received into the home, administered, and unwanted medicines returned to the pharmacy were found to be well maintained. Care plans give clear guidance to staff on how to administer any medicines that have been prescribed on an ‘as required’ basis. There were good records to show that prescribed creams and lotions have been applied according to the GP’s advice. Staff have received some basic training by the home on the safe administration of medicines. However the manager Angela Martin said she had experienced difficulty in obtaining more in-depth training for staff. Advice was given on how to ensure staff receive adequate training to ensure they are competent in this task. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 17 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. People are protected from abuse by carefully recruited and well-trained staff. Good procedures are in place to enable people to express complaints or concerns and to ensure they are dealt with promptly and appropriately EVIDENCE: The home has a clear procedure for dealing with complaints. This is displayed in the office, near the front door, in the Service User guide, and on the Sense intranet. Required checks have been carried out before new staff have been confirmed in post to minimise the possibility of abuse. Staff have received comprehensive training and guidance on the protection of vulnerable adults and there are plans to provide refresher training in the next 12 months. The staff confirmed that they are fully aware of the procedures to be followed if they suspect poor practice or abuse has taken place, and were confident that it would be dealt with appropriately. Staff said they can contact the manager at any time of the day or night for advice or guidance if they have any concerns. Records seen during the inspection, and communication over the last year with the home showed that they are fully aware of current adult protection procedures and have involved other professionals appropriately to seek advice on any issues that have arisen. Records have been maintained in the home of issues that have arisen and how these have been resolved to everyone’s satisfaction. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 18 The home plans to further improve communication methods with people living at the home to help them express any concerns or complaints they have. Records of money handled by the home on behalf of the people living there were seen during this visit. Records of all transactions have been carefully and clearly recorded. Records showed that a member of staff and an observer have both signed to say the transaction and balances are correct. The finances in the home have been regularly audited by Sense and the last report was seen. This showed that good procedures have been followed to safeguard the money and belongings of the people living at the home. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well maintained, comfortable and safe home. EVIDENCE: In the last year the exterior of the house has been repainted. The first floor corridor has also been repainted, although the stairwell and ground floor hallway are still waiting to be decorated, along with the bedroom doors. In a tour of the house we found that the overall appearance of the house is bright, clean and homely. People have a single bedroom of good size. Each bedroom has been personalised to suit the personality and tastes of the individual. One bedroom had a broken chest of drawers and the manager agreed this was in need of replacement. The bathrooms were clean and in good order, although in one bathroom a brightly pained mural was beginning to show signs of peeling paint and looking faded. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 20 The lounge and conservatory are bright, well furnished and comfortable. The back garden has been laid out with sensory areas, lawns and sitting areas. At the time of this inspection the lawn was in need of mowing, but this was due to recent poor weather. One person living at the home enjoys mowing the lawn and the staff said that the next dry spell of weather they will mow the lawn and tidy the garden. Angela Martin said they plan to purchase new garden chairs and table. The kitchen is modern and well equipped. The laundry was found to be in good working order, neat and tidy. The home is equipped to meet the sensory and mobility needs of each person living there. Tactile signs, flashing doorbells, and grab rails have been provided where needed. All areas of the home were found to be clean and free from any odours. Good cleaning routines are in place. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 21 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, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made to the level of permanent staff in the last year resulting in a committed and skilled staff team who are able to meet the needs of the people living at Applemead. Good recruitment procedures have been followed, ensuring that people are safeguarded from abuse. The staff are well trained. EVIDENCE: The files of seven staff who have been recruited in the last year were checked. These files provided good evidence to show that the home has followed careful recruitment procedures, obtaining at least two satisfactory references, a completed application form with full employment history, and criminal and protection of vulnerable adults checks have been carried out before a new member of staff has been confirmed in post. Records of induction training given to each member of staff have been completed and signed to show that each recommended topic has been covered. Staff told us that they felt their recruitment and induction had been Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 22 thorough and provided them with sufficient knowledge to enable them to carry out their work with confidence. A training matrix is completed each month by the home and sent to their head office. Records of training seen during this inspection showed that the staff have received a wide range of training and updates. On the first day of this inspection the majority of the staff team were present for the whole day for two training sessions, morning and afternoon. The staff talked about some of the topics they have received training in. They said that they receive regular training on all health and safety related topics, and also topics that are relevant to the health and personal needs of the people living at Applemead. Any additional training they needs are identified through their regular supervision sessions. Staff said that Sense is committed to providing a good level of training and has always endeavoured to find specialist courses if staff have indicated a need for these. They talked about sign language courses, and training in other communication methods. In the last year training has included challenging behaviour, deaf/blind awareness, autism, bereavement, and mental capacity and consent. Once staff have completed their probationary period they are supported to complete a nationally recognised qualification in care (NVQ level 2 or 3 in care, and the Learning Disability Award Framework). Seven staff currently hold an NVQ and two more have just started an NVQ course. Of the remaining three staff one holds a nursing qualification. In the last year the proportion of permanently employed staff has risen and the number of agency staff has fallen. This has resulted in a significant improvement in the morale of the staff team. The staff said they generally felt very well supported by the manager and by Sense. Where some problems were raised by the team the manager demonstrated a commitment to addressing problems and to building a positive and supportive working environment. The staff said they are able to talk to the manager at any time of the day or night if they have any concerns. While recruitment of permanent staff has improved in the last year some posts continue to be covered by agency staff. Most of the agency staff have been visiting the home regularly for a considerable period of time and have therefore developed close links with the home. Many of the agency staff have received essential training by Sense. However, Sense have recognised that they need to address recruitment problems if they want to further improve the staff morale, the level of commitment, and the expertise of the staff team. From discussions with the manager and the Responsible Individual it was clear that Sense are actively considering ways of addressing this. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 23 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 excellent. This judgement has been made using available evidence including a visit to this service. People live in a home that is well-managed and safe. EVIDENCE: Angela Martin was registered as the manager of Applemead in May 2006. She has had previous experience as a registered manager of another home for several years. She has just completed the Registered Manager’s Award and will begin a nationally recognised training course know as NVQ level 4 in September 2007. Sense have a good range of methods of checking the quality of the service provided and to ensure continual improvements are made. A monthly audit is carried out by the Responsible Individual of all management processes within the home. These have been forwarded to the Commission. Sense carry out Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 24 their own annual surveys of residents/relatives/professionals views on the home and the results of the last annual quality audit of the home was seen in report form. This report is available for staff and relatives to see how the home is performing. It was not possible to see individual responses from relatives during this inspection and therefore it was agreed that the Commission will send out survey forms to relatives and professionals separately. While the responses will not be received in time to inform the judgements in this report, any issues arising from the surveys will be addressed individually with Sense. Records of all health and safety required checks and risk assessments were seen. The fire log book showed that equipment has been regularly tested and serviced, and staff have received regular training on fire safety procedures. The accident book was completed satisfactorily. Risk assessments on the environment were in place and actions to reduce or eliminate any risks were seen to be carried out. Staff have received regular training and updates on all health and safety related topics. Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 4 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 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 3 X 4 X X 4 X Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. 1. Refer to Standard YA20 Good Practice Recommendations Staff who are responsible for the safe administration of medicines should receive training to a nationally recognised standard, and the home should be able to demonstrate that the staff are competent in this task. Furniture in residents’ bedrooms should be in good repair. Interior paintwork should be repainted where necessary, particularly in the staircase and upper corridors. 2. 3. YA24 YA24 Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Applemead DS0000021878.V339526.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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