Inspection on 07/06/06 for Appleton House

This inspection was carried out on 7th June 2006.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Appleton House 13/03/06

Appleton House 05/05/05

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME ADULTS 18-65 Appleton House 26 Chafen Road Bitterne Manor Southampton Hampshire SO18 1BB Lead Inspector Christine Hemmens Unannounced Inspection 7th June 2006 10:00 Appleton House DS0000061570.V289386.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 Appleton House DS0000061570.V289386.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. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleton House Address 26 Chafen Road Bitterne Manor Southampton Hampshire SO18 1BB 02380 286290 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) Truecare Group Limited Miss Tracy Marie Creagh Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2006 Brief Description of the Service: 26 Chafen Road also known as Appleton House is situated in the Bitterne area of Southampton. The home is registered for seven service users with mental health needs. The large detached home consists of seven individual flats, which contain en-suite facilities and basic kitchen areas. The home also provides a separate service user kitchen and communal lounge and dining area. To the front of the property is a small garden and to the rear is a large landscaped garden. The home is situated close to local shops and amenities and a short car or bus journey away from Southampton city centre. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out by one inspector. All key standards were viewed with the assistance of the registered manager, staff and a resident. Several other residents were approached however declined to speak with the inspector. A tour of the premises was undertaken which included viewing a resident’s room and all communal areas of the home. Records were inspected. Feedback was provided to the registered manager at the end of the inspection. What the service does well: The manager and her staff demonstrate that they provide a stimulating and comfortable environment for the residents to live, where they can express their individuality and have their personal health and welfare needs met using a person centred approach. The inspector observed the residents to be happy, active and supported respectfully by staff. One resident with whom the inspector met said he had only been living in the home a short period of time but had been helped to settle well and already felt at home. “The manager is very good, she listens to me and has helped me to settle in”. The home does well to provide prospective and current residents with information about the home, and undertakes an assessment prior to moving in to ascertain if the home can meet the needs of the perspective resident, in addition the manager meets with the residents prior to them visiting the home. A resident informed the inspector that he had visited the home on several occasions before moving in but knew he liked the home from the first visit. The home does well to involve residents in planning their care, having a say about how they wish to have their support needs met and to take risks as part of working towards an independent lifestyle. The inspector saw evidence of good practice in supporting residents to be independent such as going shopping, preparing meals and engaging in leisure pursuits. The inspector observed staff respectfully engaging with a resident in a monthly meeting and on another occasion staff providing informed choices to minimise risks to the resident. A resident informed the inspector that he liked his monthly meetings with his keyworker because it allowed him to have a say about how he wants to be treated. The home does well to provide the resident with information on how to complain and protects them from potential harm of abuse. A resident informed the inspector that he was confident that the staff and the manager would listen to him and help him resolve any concerns he may have. There is evidence that complaints are appropriately logged and dealt with. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 6 The home is spacious, clean and furnished with quality furnishings, each resident has a bed-sit of their own, with en-suite facilities and a kitchenette, allowing the residents to develop independent living skills. The home does well to support the residents with suitable numbers of qualified, experienced and supervised staff. Through the course of the visit the inspector observed staff going about their roles and responsibilities confidently and in an organized fashion. Residents were observed to be well supported, advised and engaged with staff. One of the staff members with whom the inspector met said she really enjoyed her work and demonstrated a clear understanding of the purpose of the home and her role to support the residents to become independent, express their wishes, and to have their privacy and dignity respected. The residents do well to benefit from a well managed home where they are confident their views will be heard and where their health, welfare and safety are protected as far as feasibly possible. The manager was observed to confidently manage the home, the staff and support the residents respectfully. What has improved since the last inspection? What they could do better: The outcome of this inspection overall found the home to provide a good service for the residents, this was demonstrated through observation and discussion with residents and staff on the day of the visit, however the manager is aware that there is always room for improvement and was keen to discuss how this could be done. The manager is in the process of reviewing the Statement of Purpose and Service User Guide and was advised to produce and accessible format for those that may require support with cognitive and sensory needs; the manager was also made aware that a revised copy must be sent to the Commission for Social Care Inspection. The manager could do better to ensure when she assessing the needs of prospective residents that she obtains as much information about their primary Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 7 needs as possible to avoid admitting those whose needs cannot be met. The manager was made aware that to admit out of category is an offence. The manager is aware as mentioned above of the importance of using appropriate language and ensuring her staff are fully aware of the importance of respecting the residents as individuals with feelings and needs. ** The home has very good systems for storing and administering medication and staff are trained, however the process of double dispensing goes against the Royal Pharmaceutical Guidelines and the manager was informed she must seek advice from her local dispensing pharmacist to ascertain how this practice can be made safe or replaced with an alternative procedure. The home generally provides a safe environment for the residents to live where appropriate checks on health and safety are undertaken with the support of the residents, however the home fails to take regular checks on fire alarms. The last recorded test took place on 11/05/06, the manager is aware of the potential risk to both residents and staff. The communal kitchen poses risks to the residents also, the layout and ergonomics of the kitchen are not conducive to safe working practices especially when preparing and cooking meals. The manager is advised to seek advice from an appropriate professional to establish to better layout of the kitchen. 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. Appleton House DS0000061570.V289386.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 Appleton House DS0000061570.V289386.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 4 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide prospective and current residents with information about the home, however some improvements to the Statement of Purpose and Service User Guide accessibility are advisable. The home does well to assess prospective residents, however the home must ensure it is aware of residents placing criteria before accepting them. The home does well to provide prospective residents with opportunities to visit the home to ascertain if it will meet their needs. EVIDENCE: There was discussion regarding the current work the manager is undertaking to review and revise the Statement of Purpose and Service User Guide. The information contained in both provides prospective residents with an overview of the service and the facilities they can expect. Four “Have Your Say” comment cards received from resident said they had received information about the home. However the manager acknowledges that she has slightly confused the two documents. The inspector provided advice and in addition discussion took place on how the Service User Guide could be provided in an accessible format for Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 10 those who may have sensory and cognitive disabilities. The manager demonstrated enthusiasm to get them right for the residents. A resident who had only been living in the home for a short period of time said he was already familiar with the home and was complimentary of the manager and staff support he receives. The home undertakes a pre-assessment process for prospective residents. In addition the home obtains an assessment from the placing authority. The manager informed the inspector that she does not undertake the assessment process personally as the service has a placement manager who undertakes the initial assessment, discusses it with the manager who then visits the individual and then agrees if the home can meet the residents needs. This has its benefits however the manager must be certain to obtain as much information as possible to avoid potentially admitting a resident outside of the categories for which the service is registered. The assessment document is comprehensive and covers all aspects of the residents’ health and welfare, strengths and needs, likes, dislikes, hobbies and interests and social and spiritual beliefs. Prospective residents are supported to trial the home and arrangements are made for them to visit the service for a day, for a meal, overnight stay and by extending the length of the visits until the resident feels happy to move in. A resident with whom the inspector met confirmed that he had made several visits before moving in, although was very happy with the home from the start and couldn’t wait to move in. Another comment made in the “Have Your Say” comment cards said the resident hade visited the home several times before moving in. This evidences the home takes seriously the need to ensure that residents are carefully supported through their transition period and to ensure they can meet their needs. Appleton House DS0000061570.V289386.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7and 9 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to involve residents in planning their care, having a say about how they wish to have their support needs carried out and to take risks as part of working towards an independent lifestyle. The approach adopted by the home is person centred. However the manager is advised to support residents to sign they are in agreement with their plans. EVIDENCE: The inspector viewed three personal plans. The home does well to hold important and relevant information such as the individual’s DOB, NOK, placing authority contact details and lists all other health care professionals and important people in the residents life. The personal plans provide an insight to the residents’ strengths, needs, physical and mental health history, wishes and desires. The care plans are Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 12 clear and specific providing information on the area of support required and how the support is to be carried out. The home keeps very comprehensive daily records providing detailed information on the residents’ day. In addition risk assessments are thorough and provide staff with detailed information on potential risks and how to minimise these. There is evidence that the residents are involved in their care planning and risk assessment process. Information collected and recorded is reviewed monthly with the residents and their keyworker at which point they discuss what has gone well for the resident, what has not gone so well and what is it they need to do to improve skills what they wish to do socially, or for a hobby or interest. The inspector observed one of these meetings on the day of the visit and later the resident informed the inspector that he enjoyed the meetings as it allowed him to express how he was feeling, what support he felt he needed to do the things he wants to do. However the manager is advised to encourage the residents to sign their personal plans when they are reviewed. The inspector observed staff supporting a resident to make a decision about where to go to buy some personal items, they were observed providing him with informed choices. This was undertaken respectfully and a compromise was reached that did not impinge on the resident’s wishes. Appleton House DS0000061570.V289386.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to support and the respect the rights of the residents to undertake appropriate peer, social and cultural activites, take part in community activities, maintain and develop relationships and maintain a healthy diet. EVIDENCE: The home has adopted a person centred approach that ensures the needs, wishes and desires of the residents are upheld unless detrimental to their health and welfare. The inspector observed throughout the course of the inspection and by speaking with a resident and member of staff that the residents are encouraged and supported to undertake daily activities be it daily living skills, social skills or participating in an activity of their choice. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 14 Residents were observed coming and going through out the day involved in various activities such as college, leisure pursuits and going shopping. The home has an activity budget that allows the residents to access places of interest, go for a ride in the forest and enjoy a pub lunch to name but a few. The home was buzzing with excitement on the day of the inspection, as some of them were off to play and officiate a football match held between houses in the Truecare organisation. The residents were also excited about the forthcoming football World Cup and the manager was making arrangements to decorate the home and provide snacks and beverages to celebrate the day like everyone else. One resident spoke at length of all the activities he is involved in including work, assisting with a children’s community group, leisure pursuits and he spoke of the support he is provided to maintain his independence. The facilities of the home allow residents to be as independent as they can be, with support if required. The manager spoke at length of the procedures and plans they have put in place to support a resident to rehabilitate back into supported living in the community. The manager recognises this may be a slow process, however there is evidence that progress is already being made. Residents are supported to maintain contact with family and friends and develop new relationships. One resident spoke about how he is able with the support of the home to maintain links with his friends and family and that his family are made welcome when they visit. Another resident regularly visits home for overnight stays. Family and friends are encouraged to take part in their relative’s reviews if the resident is in agreement. The home recognises the rights of the residents to make choices and maintain a healthy lifestyle that meets their needs and wishes, this was demonstrated throughout the course of the inspection, through discussion with a resident who stated “the staff are very good and respect me”, “I am not forced to do anything I don’t want to”, “they always knock my door before entering”, “ they provide me with support when I need it”. A member of staff with whom the inspector met was very knowledgeable of the core values and was able to verbally demonstrate how the home meets the core values. The decision made by two residents not to attend day service was respected. During the last visit to the home it was picked up that inappropriate terminology and restrictive practices were being used. The manager informed the inspector that the home has been working hard to eradicate poor terminology and care practices, the manager confirmed that this has been done through support and supervision and team meetings. However the inspector did observe inappropriate language used in a resident’s daily record. The manager confirmed that this would be addressed and would be a regular item on the team meeting agenda. This will be further monitored during the next visit to the home. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 15 The home supports residents to maintain a healthy lifestyle by supporting the resident to eat healthily. Each resident has a weekly food budget and they are supported to plan, shop and prepare their meals. Residents can choose to prepare and eat their meals separately in their bed sits if they wish, however resident requiring support are assisted by staff and can choose to eat in the communal dining room. Areas of concern or need in respect of eating are identified in the resident’s personal plan and management strategies are put in place. (The communal kitchen will be addressed in standard 24). The resident with whom the inspector met was observed making drinks and snacks independently through out the day. The inspector would like to thank him for the good cups of tea he made her through out the inspection. He informed the inspector that he enjoyed planning and shopping for his groceries and supported to make his own meals. There was evidence of nutritious foods, and fresh fruit in his room. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide support to residents in the way that they prefer and require and to ensure that their health and emotional needs are met. The home does well to ensure residents receive their medications as required, however improvements must be made on how the service support residents to self-administer. EVIDENCE: As reported in the above “lifestyle” standards the home does well to support the residents how they wish to be supported. The inspector observed and was provided with evidence from residents and staff that this is the general ethos of the home. Staff were observed respecting the rights of the residents, providing them with informed choices and negotiating compromises to safeguard the residents from risk. Monthly recorded and signed planning meetings demonstrate that the residents are fully involved in decisions about their care and support and can express what their future wishes and desires are. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 17 Choices made by the residents that could potentially comprise their health and welfare are agreed using a multidisciplinary approach. Evidence seen in the three personal files tracked for the purpose of the inspection demonstrated that the residents are well supported with their health and welfare needs. However the manager did identify in the pre inspection report that they were having difficulty obtaining a NHS dentist. This has been resolved to some degree, residents requiring emergency treatment are attending a walk in centre dental practice and then referred to a dental practice that specialises in supporting people who are anxious about attending the dentist. Currently two residents remain without a dentist, the manager confirmed that she is doing her best to sort this out. A newly admitted resident whose criteria for admission was discussed at the time of the inspection will need to be referred to and regularly monitored by a clinical psychiatrists. The manager was aware of her responsibilities to do this and is aware of the protocol of the residents after care and who needs to be involved in drawing up his plan of care. A resident with whom the inspector met said the staff were very good at supporting him with his health care needs, he informed the inspector that he attends various appointments with GPs and consultants. The accident report book demonstrates that appropriate action is taken in respect of accidents. The home supports resident to administer their medication and only the manager, team leader and senior care staff are trained to administer medication. This is done through the organisation’s own training department and support and advice is obtained from a local pharmacist who dispenses the medication. The manager has a copy of the Royal Pharmaceutical Guidelines which underpins the polices of the service. Residents are supported to administer their own medication following a risk assessment deeming them competent to do so. The residents are provided with appropriate medicine cassettes and a safe place to store their medication. However the inspector observed the practice of double dispensing, this goes against the guidance from the Royal Pharmaceutical Guidelines. The manager is required to consult with the dispensing pharmacist to agree an appropriate method and ensure staff are deemed competent to carryout whatever method the pharmacist agrees. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide the resident with information on how to complain and protects them from potential harm of abuse. EVIDENCE: The inspector was provided with evidence that residents’ views are listened to and respected. The inspector spoke with a resident who said he was confident in speaking with staff and that his concerns would be listened to. The home provides various forums where residents can express their views and air they’re concerns, such residents meetings, individual monthly reviews or an open door policy where the residents can meet with senior members of staff and the manager. This was observed at the time of the visit. Appropriate polices and procedures are in place and the residents are provided with information on how to complain. A resident said he was aware of the process on how to complain and four “Have Your Say” comment cards received from residents said they felt staff responded to their concerns. The complaint log clearly details the concern raised and how it was managed and resolved. The home has all the appropriate policies and procedures on detecting and reporting abuse and abusive practices. The home has fifty percent of its staff trained in abuse awareness, however staff receive training on abuse whilst attending induction training, NVQ and a level two certificate in Mental Health. The manager has identified other staff that need to attend the abuse awareness course. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 19 The home supports residents with complex needs and behaviours that can challenge the staff’s understanding, staff receive training management of violence and break away techniques, adopting a passive approach and only using touch support and physical interventions when the residents are deemed as placing themselves or others at risk. Clear management strategies are in place to support any form of physical intervention. The manager is fully aware of the need to clearly record incidents. The inspector was informed that some managers within the organisation have completed a “train the trainer” course and provide training to the home. The manager is responsible for ensuring the prescribed interventions adopted by the company are accredited. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 and 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide a clean and spacious environment for the residents to live. However the service is required to view the safety and ergonomics of the communal kitchen. EVIDENCE: The home is situated within a quiet residential area close to local amenities and places to visit. There is a designated parking area for a small number of cars, however parking in the area is restricted. The home is spacious and offers both individual and communal living. The home is tastefully decorated through out and furnished with good quality furniture and furnishings. Residents can choose where to spend their time. Tasteful photographs of the residents provide a personal touch to the home. The garden is small but nicely designed to incorporate a sitting area, small plants and shrubs and a reasonable sized pond. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 21 Each resident has their own bed sit which is has a kitchen and shower room facilities. A resident showed the inspector his bed-sit and spoke of how he was supported to decorate it the way the wanted and have his own furniture and furnishings. He spoke of how he had organised his room to meet his needs. The concerns raised following the last visit to the home that were compromising the residents’ safety and comfort has been rectified. Fire doors that were previously inappropriately held open have been fitted with selfclosing fire doors. The homes heating has been rectified and residents have been issued with lockable storage for medication and valuables. The home has a communal kitchen where residents who need assistance to prepare and cook meals are supported to do so, all areas of the kitchen are clean and regular checks are undertaken on appliances to ensure they are in good working order. However the kitchen does not provide enough working space and it not conducive to safe working practices. The design of the kitchen requires service users and staff preparing meals on the cooker to carry hot pans to the other side of the room through which residents pass. The manager was advised to risk assess residents using the kitchen and a requirement will be made to reconfigure the kitchen to account for the residents safety. The home is clean and tidy. The residents are responsible for keeping their own rooms clean and tidy and free from clutter. The residents are supported once a week to clean and tidy their rooms and a health and safety check is undertaken. The health and safety check is signed off by staff however the statement found in three of the files tracked for the purpose of the inspection detailed that the checks would be undertaken weekly, it appeared from the detail of the notice and that residents had not signed to say they are in agreement that the residents had not been consulted with, therefore the manager must ensure that residents are in agreement and sign if it is feasible for them to do so. It was confirmed by a resident that staff support him weekly to clean and tidy his room, he said he found this helpful as he would have a tendency to clutter his room. The home has separate facilities for laundering clothing, which are of a very good standard. The home supports the residents to undertake their laundry and this is done separately to avoid clothing going astray and the possibility of cross contamination. Staff are provided with gloves and aprons when dealing with contaminated waste. The home has policies and procedures on infection control, however not all staff have received training, and this was discussed. Staff should be specifically aware of cross contamination from bodily waste such as blood. The manager agreed to ensure staff receive training. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to support the residents with suitable numbers, qualified, experienced and supervised staff team EVIDENCE: The home does well to recruit adequate numbers of staff to meet the needs and the number of residents. At the time of the visit the home had enough staff to support residents in individual activities and this was observed throughout the visit. The home currently has twelve staff covering the home twenty-four hours a day. The staffing levels as observed during the visit, the duty rota and through discussion with the manager there are five staff from 08.00 – 16.00. Four staff 16.00 – 22.00 and two staff up an awake during the night. The manager deploys her staff effectively to ensure the resident’s personal and social needs are supported, and staff meet with the resident monthly to establish what they want to do and how this can be supported. The home has currently more staff than required as it has been managing staff who will be moving to a new service when it opens, once they have be Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 23 redeployed this will leave one vacancy. The home only uses agency staff when absolutely required, these staff are blocked book and staff who have worked in the home before so familiar with the routines and procedures. The home is proactive in ensuring staff are suitably qualified to support the residents, the manager produced evidence that 60 of the staff have undertaken an NVQ and appropriate training to meet the needs of the residents including a through inductions when they commence employment. The inspector met a member of staff who confirmed that she felt suitably supported to undertake the training she feels she needs to undertake her roles and responsibilities. The inspector saw evidence of staff training certificates to include mandatory training such as first aid, health and safety, manual handling, food hygiene and fire safety. In addition the majority of staff have received training in the management of violence and the Community Mental Health Certificate Level 2. The manager informed the inspector and provided evidence that she has requested specific training for the forthcoming year such as safe handling of medicines, infection control, abuse awareness schizophrenia, personality disorders, obsessive compulsive disorder and depression. This will be monitored during the next visit to the home. However this demonstrates the manager has seriously considered the training needs of her staff and the importance of having suitably qualified staff. The member of staff the inspector met was very enthusiastic about working in the home, describing every day as diverse and enjoyable. The member of staff appeared fully aware of her roles and responsibilities the emphasis being on supporting the residents to be independent, develop new skills, helping to make choices, become part of the community and to reach their full potential. The member of staff was enthusiastic with the monthly meetings with the resident in order to agree new goals and was very complimentary of the manager who she was very keen for this to happen. Staff were observed working and interacting well residents, spending time listening and supporting them to do the things they want to do. The staff appeared happy in their work and a relaxed and organised atmosphere was felt. The inspector was informed that staff are recruited through the services recruitment department and all appropriate checks are obtained before commencing in the home. The manager provided evidence of this and advised that she assists with the recruitment of staff. The manager may wish to consider involving the residents in interviewing staff. The manager informed the inspector that staff are regularly supervised and team leaders have received training in support and supervision. A staff Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 24 member confirmed that she received regularly support and supervision and her objectives linked to those of her roles and responsibilities and the resident/s she is keywoprker to. The inspector saw evidence of staff receiving supervision. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 25 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): 37,39 and 42 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The residents benefit from a well managed home where the residents are confident their views will be heard and where their health, safety and welfare are protected as far as feasibly possible. However the manager must ensure residents and staff are protected from the potential risk of fire. EVIDENCE: The inspector spent time during the visit with the manager who demonstrated good leadership, good values and respect for the residents and staff. The manager communicates well with her team and the residents, applies an open door policy and is open to advice to improve the service. The inspector demonstrated a good understanding of her roles and responsibilities as a registered manager and is enthusiastic to improve her management skills. Residents and staff were both very complimentary of the manager, “I know I can go to her whenever I want and she will listen to me”, “she is very Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 26 supportive”. The manager was modest and said she put it down to having a very good management team who are competent and as enthusiastic. The home and the organisation demonstrate the importance of seeking the views of the residents, staff, relatives and other professionals such as social workers and CPN’s. The inspector was informed that the service had recently undertaken a quality review of its services and residents and their families were requested to complete questionnaires. The outcome of the quality audit is yet to be published. The manager is advised to forward a copy to the Commission for Social Care Inspection once its findings have been published. However the home can demonstrate that is regularly seeks the views of the residents and staff through open and closed forums such as team and resident meetings, residents monthly meetings, staff hand over and staff supervisions. The Commission for Social Care Inspection regularly receives copies of regulation 26 visits, which includes observing day-to-day activities, speaking with residents and staff, viewing the environment and making recommendations of any actions required. The inspector was able to obtain evidence that the manager had actioned these recommendations and meet the requirements issued following the last visit to the home. The manager was able to demonstrate that she and her staff as far as feasibly possible protect and safeguard the residents from potential harm. A tour of the home established that the previously made immediate requirements to stop inappropriately holding fire doors open and to ensure the homes heating is working correctly has been addressed. The home is clean and tidy and free from potential hazards to the residents other than that identified in standard 24 regarding the residents’ communal kitchen. The residents are responsible for keeping their rooms clean and tidy and free from clutter. The residents are assisted weekly to undertake a health and safety check of their room. A resident informed the inspector said he didn’t mind this, as it is important to be kept safe. Records seen demonstrate that the manager ensures regular maintenance and servicing of equipment is undertaken and substances hazardous to the health and safety of the residents are house in a safe place. Temperature controls on fridge’s and freezers are regularly monitored and safety signs are clearly visible around the home. The inspector saw evidence that staff undertake regular health and safety and fire training. The home has a daily allocated fire marshal responsible for ensuring the home is free from potential hazards and reporting to the manager any concerns. The inspector saw evidence of regular fire drills and training taking place. Records demonstrate that fire equipment is regularly checked and evidence of evacuation, however the inspector observed that the home had fallen behind for nearly a month in checking the fire alarms. The manager Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 27 must ensure they are tested and recorded weekly, failure to do so could place the residents and staff at risk. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 28 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 2 2 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 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 3 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 2 X 3 X 3 X X 2 X Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 29 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. 2. Standard YA20 Regulation 13(2) Requirement The registered manager must seek the advice of the dispensing pharmacist on double dispensing and take appropriate action. Timescale for action 21/07/06 3. YA42 4. YA24 23(4)(c)(v) The registered manager must ensure that weekly-recorded checks are undertaken on fire alarms. 13(4) The registered manager must 23(2)(a) take whatever action she considers necessary to ensure residents using the kitchen are protected from risk. 07/06/06 31/07/06 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 The registered manager is advised to make appropriate changes to the Statement of Purpose and Service User Guide and forward the revised copies to the Commission for Social Care Inspection. DS0000061570.V289386.R01.S.doc Version 5.2 Page 30 Appleton House 2 YA39 The registered manager is advised to send a copy of the homes annual quality audit to the Commission for Social Care Inspection. Appleton House DS0000061570.V289386.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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