Inspection on 28/06/05 for Appletrees

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Appletrees 07/08/08

Appletrees 14/08/06

Appletrees 07/11/05

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 Berks RG7 6PB Lead Inspector Susan Cledwyn-Davies Unannounced 28 June 2005, 9.20am-1.50pm 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 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 Stationary 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. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Appletrees Address Chapel Row, Bucklebury, Berks, RG7 6PB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0118 9713769 CHOICE lTD Mr Paul Robert Thwaite Care Home (CRH) 8 Category(ies) of Learning disability (LD) 8 registration, with number of places APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6 January 2005 Brief Description of the Service: Appletrees is a care home for seven adults with learning disability and is situated amongst open countryside. All service users have their own bedrooms that are appropriately individualised. A large garden is provided for residents use together with a kitchen, 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. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 9.20am and 1.50pm. Included in the inspection was a partial tour of the building, discussion with the manager and 4 staff, contact with all service users, and examination of the records. It was agreed with the manager that the term service user would be used in the report. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 7 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 standard(s) 1 and 5. The statement of purpose is up to date and available. Each service user has a written contract of terms and conditions. EVIDENCE: The statement of purpose is available and has been recently updated. The service user guides were not seen during this inspection. Individual terms and conditions are kept for service users in the care plans. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 8 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 standard(s) 6, 7 and 9 Service users have an individual plan based on their assessed needs. Service users take an active part in the home and are supported with risk assessments and other strategies to be independent. EVIDENCE: Individual plans reflect service users needs. Care plans are kept in the office with easy access for staff. Monthly reviews of all care plans are taking place, there are some delays in the last reviews because staff are away with service users on holiday. Annual reviews are taking place. It was noted that the older reviews are kept in the care plan files. It was discussed and agreed that the files would be updated to contain the most recent reviews. Service users were given options during the day and their views respected. There were a variety of activities taking place and all staff took part in different activities. The manager advised that service user meetings had not taken place in the last few months and that he was arranging one shortly. Risk assessments and behaviour strategies are used to encourage service users to go out in the community and try different activities. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 9 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 standard(s) 13, 14 and 17 Service users are part of the local community and take part in a selection of leisure activities. Service users are offered a varied diet and enjoy their mealtimes. EVIDENCE: Two service users were away on holiday with two staff from the permanent team. During the visit there were a variety of activities taking place. These included horse-riding, drawing, using the internet and household activities. Service users were encouraged to take part. The meals provided included one night a week that was service users choice. The group took it in turns to pick the meal for this evening. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 10 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 standard(s) 18 and 19 Service users receive personal support in the way they prefer and service users health needs are met. EVIDENCE: Service users have an individual daily routine and staff respect these differences. This was confirmed during the visit. Health needs are met initially by the local GP surgery. During the visit one service user was preparing to attend the local surgery for an injection. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 11 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 standard(s) 22 and 23 Complaints are listened to and acted upon. Service users are protected from abuse. EVIDENCE: There is a clear complaints policy. There is an outstanding complaint against the Manager and there is an investigation by an independent consultant in progress. There is a good understanding of services users rights. Staff training has taken place for most staff in the protection of vulnerable adults. There is a continuous adult protection investigation with police involvement. The Manager and Proprietor have taken appropriate action. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 12 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 standard(s) 24, 28 and 30 Service users have a comfortable and safe home that is kept clean and hygienic. EVIDENCE: The house is comfortably decorated and furnished. The maintenance supervisor visited to complete some repair work. There was a previous requirement to give serious consideration to extending the lounge. The result has been that the lounge is not being extended. The concern is that some service users have challenging behaviour and this makes the small lounge difficult for the number of service users and staff. This may not be realistic on a daily basis. Therefore the Manager has agreed to monitor incidents in the lounge over the next 6 months and the next inspection by CSCI will take place in the evening. The washing machine, dishwasher and dryer have all broken down and are waiting for parts and repair. The laundry is being done locally. The parts should be available in the next week. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 13 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36. Competent staff supports Service users. There are satisfactory numbers of staff on duty. Staff receive training and are supervised adequately. EVIDENCE: The staff group is small; there are a number of vacancies. The Proprietor is looking at a number of strategies to introduce new staff. In the interim agency staff are used. The agency staff met during the visit had completed mandatory training prior to coming to the home. The Manager aims to keep agency staff for as long as possible as it is important to become familiar with service users. The staffing levels of a minimum of four carers on duty plus the Manager during the week, plus two staff on duty at night. Activities support staff will be employed during the day; at present these are vacancies. To promote service users independence and encourage normal life the Manager is trying to introduce more evening staff to enable social trips out. He is discussing an additional staff member in the evening to provide sufficient staff. There are six staff completing NVQ training at level 3. The staff group is depleted at present so it is very positive that NVQ training is continuing. Individual supervision of staff is being maintained. Staff meetings take place mainly monthly. Records were seen of these. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 14 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 There is a registered manager providing clear and experienced management. The health and safety of service users is promoted. EVIDENCE: The manager has now completed the registration under CSCI. He is in the process of completing NVQ 4 in Care and Management. The manager offers clear guidance and proactively supports service users to extend their daily lives. Health and safety is promoted. This standard was partially covered. Fire precautions are well maintained. Temperature checks of hot water and Fridge and freezers checks are maintained. There are occasional spaces and staff monitor to ensure that checks are made and recorded. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 15 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 2 x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 APPLETREES Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 16 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 28 Regulation 23 Requirement It is required that the number of incidents taking place in the lounge be monitored. Timescale for action 1.1.06 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 6 Good Practice Recommendations It is recommended to ensure that only the most up to date and/or relevant reveiws are kept with the care plans. APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection 2nd Floor, 1015 Arlington Business Park Theale Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI APPLETREES H52-H01-S11189-Appletrees-V228011-280605Stage 4.doc Version 1.40 Page 18 - 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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