Inspection on 14/08/06 for Appletrees

This inspection was carried out on 14th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Appletrees 07/08/08

Appletrees 07/11/05

Appletrees 28/06/05

Appletrees 06/01/05

Appletrees 28/09/04

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

CARE HOME ADULTS 18-65 Appletrees Chapel Row Bucklebury Berkshire RG7 6PB Lead Inspector Tracy McGuire Brown Unannounced Inspection 14th August 2006 10:00 DS0000011189.V297894.R02.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 DS0000011189.V297894.R02.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. DS0000011189.V297894.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appletrees Address Chapel Row Bucklebury Berkshire RG7 6PB 0118 971 3769 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) Choice Limited Mr Paul Robert Thwaite Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000011189.V297894.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Appletrees is a care home for eight adults with learning disability and is situated in countryside location but close to the local shop and public house. All service users have their own bedrooms that are appropriately individualised. A large garden is provided for residents use together with a kitchen, lounge/ dining room and separate lounge. The needs of the current service users are complex and comprehensive assessments are undertaken on an individual basis and are updated and reviewed regularly. All residents are actively encouraged to take part in the community and many outings and trips outside of the home are organised. The current fees are £1,682- £2,166 per week. DS0000011189.V297894.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The service was inspected over a period of 4 days between 17th July and 17th August with a visit to the establishment taking place on 14th between 10.00 am and 3.45 pm. The Inspector spoke to service users and staff. Resident files and care plans were seen. Information from providers, other professionals and inspection records were used. The Inspector toured the building and observed practice throughout the visit. What the service does well: What has improved since the last inspection? Since the last inspection there has been some improvement to the home, the cooker and hob have been replaced. There has been a change to the use of some of the communal space, the lounge and dining room have been moved around to create a lounge/dining room and a separate lounge and this is a positive move for the residents, creating more choice of lounge areas. Some new lounge furniture has been purchased. There have also been some renewals and redecoration in some resident’s rooms. DS0000011189.V297894.R02.S.doc Version 5.2 Page 6 The medication records were complete and a training profile had been developed. The Manager has started NVQ 4 in Car and Management. 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. DS0000011189.V297894.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011189.V297894.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The Quality in this outcome area is good. Assessments are undertsaken prior to admission and service users are continually monitored and assessed. This judgement has been made using available evidence including a visit to the service EVIDENCE: Following a discussion with staff and examination of the PIQ, there have been no new admissions since the previous inspection. The records of 3 service users were case tracked and ongoing assessment work was evident on these files including care management reviews . The organisation has a policy and procedure in place for referrals and admissions. DS0000011189.V297894.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,and 9 The Quality in this outcome area is good, detailed care plans and risk assessment are in place. Staff support and promote decsision making skills. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The records of 3 service users were examined and case tracked.Each Service User has an individual care file.Care plans are detailed and brokendown into different sections.Care plans detail the requirements of care and how these are to be carried out in practice.The Inspector was able to observe care plans being put into practice on the day of the site visit. There is additional information about service users including guidelines and risk assessments.Risk assessments are in place to protect each individual service users and samples of these were seen in record examination the individual and promote independence, this is particuarly important due to the complex and challenging needs of the service users in this home Monthly monitoring sheets are completed to review each months progress.There is also guidance for completion of achievement charts to promote positive encouragemnent. DS0000011189.V297894.R02.S.doc Version 5.2 Page 10 Staff in the home promote the decision making skils in a variety of ways, some are detailed in care plans , with relevent guidelines and risk assesments in place. In addition the use of picture cards and signs help service users to decide on e.g drinks , meals and activities.The home is service user focused and the complex learning, communication and behavioural needs are not a barrier to decision making in the home. DS0000011189.V297894.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16 and 17 The Quality in this outcome area is good. Service users have full and varied individual day care opportunities and their persoanl development is promoted. Their rights are respected and they are supported to maintain important relationships. Service users have a healthy diet. This judgement has been made using available evidence including a visit to the service EVIDENCE: Personal development is an important factor in this home and service users records seen demonstrate that staff work hard to promote this e.g. one service user is being encouraged to use objects of reference and pictures to communicate instead of grabbing and leading people. This is building the confidence of this service user. Pior to the inspection the Manager supplied copies of the weekly planners and theses were rflective of the day care offered.Since the previous inspection the home has employed a day care person. In addition the home has its own day care building situated acroos the car park from the home. The home has extensive grounds available and thses were put to good use growing plants and vegetables.3 service users were case tracked and each service user has an individual day care programme. It was noted that these programmes are developed in conjunction with guidelins and risk assessments.On the day of DS0000011189.V297894.R02.S.doc Version 5.2 Page 12 inspection one service user went to and external horticultural day care session.Records viewed show that service users undertake a variety of activities including:swimming, cooking, gardening.college . music, stepping stones,offshoots and horseriding, these were also detailed in the pre Inspection Questionniare . The staff support required for each activitiy is carefully detailed in service user records.Day care is also flexible dependent on service users needs and issues for that day.Service users were also observed using the day care building to draw and search through catalogues. Comminity links are promoted in the service , on the day of the home visit service users told the Inspector about their visits to local shops, pubs , restaurants, bowling alley and leisure facilities.Each service user has a section in their file where the use of all community facilities is recorded, in addition the care plans have a section community living skills, care issues are detailed here. The 3 service user files case tracked detail family and friends and contact made. Contact detailed included telephone calls, e-mails and visits.Service users spoken to tole the Inspector of planned visits and telephone calls made to family, another service user was able to communicate using some speech and signs to tell the Inspector about a particular friend. In each service user file there is information about daily tasks and routines in care plans. Service users were seen interacting together and spending time alone. Staff were seen observing service users privacy. Menus were supplied prior to the Inspection and these were in a pictorial and colourful format.The Inspector observed a service user participating in the prperation of a lunchtime meal. Fresh home grown produce was available . The menu for the day is displayed in the dining room in a photographic format and a service users was observed discussing the choice, alternatives were offerred to those who wanted.There are specific care plans and guidelines in place for service users at meal times. Choosing were to eat is of particular impotance to the service users and this is respected and supported. Staff jioned the service users for lunch and it was a sociable .Service users are supported to goout and like goiong to restaurants , a service user told the Inpsector I like to go to the pub, the Mill house is my favourite , I have fish and chips and peas DS0000011189.V297894.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The Quality in this outcome area is good. Personal and healthcare support is provided to meet the needs and preferences of service users. Medication practice and procedures are appropriate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The records of 3 service users were examined closely, personal support preferences of service users were seen in service users care plans, risk assessments, and personal information. Detailed guidelines are also in place. All service users have designated key workers who help ensure the consistency of care. There was positive promotion of independence noted for example one service user is being supported to wash her own hair by a small change in care routine giving a small amount of shampoo instead of the bottle, this allows this person to work to achieve this goal and build self esteem. Records were case tracked and each service users records sampled had an health action plan, in addition there is a file which details all medical and healthcare appointments including specialist intervention e.g. psychology. Staff spoken to demonstrated sound knowledge of the different health issues of each service user. The Inspector was informed that medication in the home is administered by trained staff only. Training is in the form of shadow training and the completion of an assessment. The lunch time medication routine was DS0000011189.V297894.R02.S.doc Version 5.2 Page 14 observed, staff prepare the designated medication room and then 2 staff are present, one administer and call out the name dosage and medication, the other person double checks and both people sign. Service users only come in the room one at a time. Samples of MAR sheets were examined and there were no gaps in recording. Staff spoken to had sound knowledge of medication procedures. Detailed guidelines are in place for the administration of PRN medication. DS0000011189.V297894.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The Quality in this outcome area is good. Service users views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is a robust complaints procedure, which is advertised. All complaints are responsibly investigated and managed. There has been one complaint since the last inspection from a service user, which was dealt with appropriately. The organisation needs to ensure more training in the protection of vulnerable adults is available to all staff. DS0000011189.V297894.R02.S.doc Version 5.2 Page 16 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 and 30 The Quality in this outcome area is good. The home is comfortable , safe and clean and tidy throughout. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A tour of the premisies was undertaken paying particulat attention to the areas mentioned in the previous inspection report. Since the previous inspection there have been 2 new cookers and a new hob installed all were reported to be in working order.The kitchen was generally clean and tidy, the flooring in need of some resealing to allow effective cleaning to continue, this will be a recommnedation of this inspection. The large lounge had been changed into a lounge and dining room and the dining room was being used as another sitting room , this seemed to be well utilised and popular with service users giving them the choice of where to sit. There were some new sofas and furniture in the lounge. The home has a large garden which is also used and one service user enjoys eating in the garden in the summer months. The first floor bathrooms were clean and tidy and well decorated, the ground floor bathrooms are in need of some maintence work , particuarly the flooring which is lifting and not sealed in areas making effective cleaning difficult.. The home has a laundry area , the house was clean and tidy throughout. DS0000011189.V297894.R02.S.doc Version 5.2 Page 17 DS0000011189.V297894.R02.S.doc Version 5.2 Page 18 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): The Quality in this outcome area is good, recruitment practice is sound and service users benefit from a trained and skilled staff team. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Manager informed the Inspector in the PIQ and at the inspection that since the previous inspection 3 staff have been dismissed and 3 recruited. There are currently 2 vacancies. Staff spoken to were positive about the staffing levels at present but there is some concern as some staff are due to leave soon when their particular contracts end. It is essential due to the needs of the service user send to maintain consistency and continuity in the home that vacancies are recruited to as soon as possible. The home does currently use some regular well-known bank staff to cover any current gaps and the staffing levels are satisfactory. Samples of staff records were looked at. The Manager informed the Inspector that the organisation intends to keep staff records and the head office in future.Records shown included all required recruiment documents, supervison, appraisals and copies of training course certificate.The Manager also sent a current training profile fr the home prior to the visit to the home.The Manager discussed the recruitemnt processes with the Inspector and has sound knowledge. The head office deal with the relevent checks that need to be undertaken and liasise with the Manager. Records examined and discussion with staff demonstrate that training is offered and staff have a range of suitable skills and abilities, more POVA training would be beneficial. Some staff DS0000011189.V297894.R02.S.doc Version 5.2 Page 19 have completed NVQs. Staff were observed working in a sensitive and proffessional manner, following care practice and guidelines detailed in care plans. Staff spoken to informed the Inspector they are happy working in the home and the staff team is good, we get on well together DS0000011189.V297894.R02.S.doc Version 5.2 Page 20 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 The Quality in this outcome area is good, the home is run well and Health and Safety is promoted.Quality assurance and the Development plan need to be updated This judgement has been made using available evidence including a visit to the servic EVIDENCE: The Manager has started his NVQ level 4 in care in management. the Mnanager alrady has a number of relevent qualifacations including the certificate in Advanced Management in care,he also has a number of years experience in care and has completed his registration with CSCI. The home has a formal quality assurance system in place and this was assessed at the previous inspection and included questionairres to service users and regular propriertor montoring visits. The home had an annual development plan in place ormulated from the Quality assurance process, however this was due for review in July and needs to be completed and updated.The home also conduct regular monthly and 6 monthly reviews to monitior the progress of all service users. DS0000011189.V297894.R02.S.doc Version 5.2 Page 21 The Inspector examined a variety of Health and safety records including, basic checks, policies , information and risk assessments. Checks are in place and undertaken on a regular basis. Training records sampled indicate staff attend Health and Safety training.The Health and Safety records would benefit from some reorganising and this was discussed with the Manager. DS0000011189.V297894.R02.S.doc Version 5.2 Page 22 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X DS0000011189.V297894.R02.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA23 YA35 YA37 YA24 Regulation 13 (6) 9 23 Requirement That more training in protection of Vulnerable Adults is accessed That the Manager completes NVQ 4 in care and Management That the maintenance issues identified (the bathroom floors) are attended to. Timescale for action 31/01/07 30/09/08 31/01/07 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 YA42 Good Practice Recommendations That Health and Safety records are reviewed and reorganised. 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