Inspection on 07/11/05 for Appletrees

This inspection was carried out on 7th November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Appletrees 07/08/08

Appletrees 14/08/06

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 Susan Cledwyn-Davies Unannounced Inspection 7th November 2005 12:45 Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 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 Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2005 Brief Description of the Service: Appletrees is a care home for eight 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 DS0000011189.V262074.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between 12.45pm and 5.25pm. Included in the inspection was a discussion with the manager and staff, conversation with residents, examination of records and a reduced tour of the building. Service users lunch was seen during the visit. There are 8 residents living in the home. 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 DS0000011189.V262074.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 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 the following standard(s): 2 Prospective service users needs are assessed prior to admission. EVIDENCE: The admission file of the latest service user admitted to the home was seen. This file showed comprehensive assessment and discussion between the provider, relatives and professionals. Visits to the home were arranged. The new service user has settled in well. Good records were kept of the admission process. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 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 the following standard(s): 6, 7 and 9 Service users changing needs are assessed and personal goals worked towards. Money kept for service users is well managed. Supported risks are taken. EVIDENCE: Care plans seen included an assessment of care needs and regular reviews. Annual reviews take place involving the service user, relatives and professionals plus the manager and key worker. Reports are received from the assistant psychologist, who visits the home weekly. Any outside day care placement also sends a report to the review. Six monthly reviews take place to check on the progress of personal goals. Monthly summaries are prepared of significant events. These summaries had not been prepared since July 05 due to shortage of staff. The staff team was now almost full and as new members of staff complete their induction then key working tasks are being achieved. Risk assessments and behaviour guidelines are prepared and amended by the assistant psychologist. Staff reviews them. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 9 The manager keeps residents’ spending money securely for them. Comprehensive records are kept clearly demonstrating where money is used and for what purpose. Two records were checked against money held and were correct. Records are audited six monthly by a member of the company. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 10 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 and 15. Service users are able to take part in a variety of activities. Service users relationships with families are encouraged. EVIDENCE: Activities are encouraged. There is no activities organiser at the moment. The post is being advertised and the manager is actively looking for a replacement. Activities take place in the home but it was said that these activities could be developed further. It is hoped that with a stronger staff team will help this. Activities away from the home are managed, depending on the availability of a driver within the staff on duty. Service users have started new activities and are all encouraged to go out as much as possible. Relationships with families are supported. Service users go to visit relatives with staff support; telephone contact is maintained. Records and discussions with staff confirmed this. Two service users have advocates that visit regularly to support them. Most service users have had holidays or outings this year. Achieving this with reduced permanent staff speaks highly of the commitment of all staff. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 11 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): 20 Medication administration is responsibly managed and safely stored. Records were largely satisfactory. EVIDENCE: Medication was well stored and records were generally good. For administration of medication the procedure from the provider states that one senior staff member administers medication and a second witnesses it. The administration records had some spaces in them; some were when only the witnessing member of staff signed and a few were when no one signed the record. Because of the complex needs of the service users and their limited understanding of the importance of the medication it is important that a complete and accurate record is kept. All staff both administering and witnessing have completed a comprehensive training and observation before being approved. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 12 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. Service users views are listened to and acted upon. Service users are protected from abuse, neglect and self-harm. EVIDENCE: There is a comprehensive complaints system, which is advertised. All complaints are responsibly investigated and managed. There have been no complaints since the last inspection. There has been an adult protection investigation instigated by the manager. The member of staff involved no longer works within the home. The police are completing the investigation. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 13 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 house is comfortable but needing a lot of maintenance work. The limited size of the lounge is part of a discussion. The house was clean and fresh smelling. EVIDENCE: The house is well-used and run down at present. A recent survey of the building by CHOICE was shown to the inspector. There is a lot of maintenance work to be completed. Additionally the hob and ovens in the kitchen need to be replaced, only a part is working safely. New equipment has been ordered. There was a recommendation in the previous report that consideration is given to providing a larger lounge. The proprietor has responded to this. There have been a number of improvements to the site including a new day care building, dining room plus additional service user bedrooms over the past few years. There are concerns about obtaining planning permission for further extensions, though an application has not been made at this stage. The communal space available is greatly improved but there are eight service users living in the home. The lounge has sufficient space for comfortable sofas for all residents; space for staff is limited. These service users need space and are Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 14 not always willing to share a sofa with another. Staff are always present with service users. While accepting the comments made about past improvements and increases in service user numbers the lounge is very restricting. Service users do not always want to leave the house to reach the day care building; there should be sufficient space within the house. The inspector’s experience of visiting other CHOICE homes is that the communal space provided in other homes is much better, well above the minimum standard. This demonstrates a good understanding of the needs of the service users. The first priority is to ensure that all maintenance work and the kitchen are completed. The inspector will continue to monitor the effect of limited communal space. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 15 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): 33 and 35 Service users are supported by adequate numbers of staff; there is an increase in the number of permanent staff. EVIDENCE: The staff team has been very depleted and agency staff have been used to maintain adequate numbers on duty. There are now only 4 vacancies and two of these have been recruited for but are awaiting final checks before starting. One vacancy is for deputy manager following her resignation. A current deputy has transferred and is completing this role temporarily. Staff morale is much better. It has been hard for all staff maintaining continuity for service users with reduced consistency and commitment of staff. Staff allocation is satisfactory to provide care for service users. Staff training is in place; all new staff are receiving comprehensive induction. The remainder of the staff have opportunities to attend training. The central training record is incomplete and does not clearly demonstrate whether all staff have received mandatory training and other training up to 5 days training a year. Having an accurate training record is made as a requirement. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 16 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 and 39 The manager is very experienced and committed. He has still to complete the NVQ 4 training. Quality assurance systems are in place. EVIDENCE: The manager has demonstrated commitment to the service users and the home. This has been a difficult year because of staff shortages. The deputy manager has left and an acting deputy in place. The manager has not been able to complete the NVQ 4 training in care and management. This is now made as a requirement because the training has been recommended for a couple of years and needs to be completed. Quality assurance in place included • Monthly regulation 26 visits by a representative of the proprietor, • Questionnaires about the service take place for service users with assistance from key workers, • Annual reviews and six monthly follow up meetings take place for each service user. • Development plan to demonstrate aims for the year. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 17 The views of outside users of the service including professionals had not been sought this year. Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 18 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 X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Appletrees Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X X X DS0000011189.V262074.R02.S.doc Version 5.0 Page 19 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 2 3 Standard 20 24 35 37 Regulation 17 23 18 9 Requirement It is required that a complete record of medication administration be kept. It is required that all outstanding maintenance works and the kitchen area be done. It is required that an up to date central training record for all staff be maintained. It is required that the manager completes NVQ 4 in care and management. Timescale for action 01/12/06 01/12/05 01/01/06 01/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Appletrees DS0000011189.V262074.R02.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Berkshire Office 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 DS0000011189.V262074.R02.S.doc Version 5.0 Page 21 - 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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