Inspection on 22/11/05 for Apsley House

This inspection was carried out on 22nd November 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apsley House 12/07/06

Apsley House 06/06/05

Apsley House 13/12/04

Apsley House 06/07/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Apsley House 103 Queens Park Road Heywood Rochdale OL10 4JR Lead Inspector Jenny Andrew Unannounced Inspection 22nd November 2005 09:45 Apsley House DS0000058327.V266118.R01.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 Apsley House DS0000058327.V266118.R01.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. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Apsley House Address 103 Queens Park Road Heywood Rochdale OL10 4JR 01706 360309 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) Mrs Linda Bell Mrs Janet Kinsella Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 4 service users, to include;up to 4 service users in the category of LD (Learning Disability) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 6th June 2005 Date of last inspection Brief Description of the Service: Apsley House is a privately owned, small care home accommodating 4 younger adults with learning disabilities who need support to lead independent lives. The home is a spacious end of terraced house near to the centre of Heywood with good access to a range of community facilities and public transport links. A park is situated close by. All 4 bedrooms have en-suite facilities and are situated on the first and second floor levels of the home. As there is no lift, the home is unsuitable for anyone with mobility difficulties. This is published in the statement of purpose. Car parking space is available at the side of the house and there is a small garden area to the rear. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over four and a half hours. The Inspector looked around parts of the building, checked care plans and some other records. In order to obtain information about the home, the manager and two support workers were spoken to in a group setting and 3 service users were spoken to on an individual basis. Since the last inspection, the manager has moved to work at another home. The joint owners, who are presently managing the home, wish to again become the registered managers and will be sending in their application form shortly. What the service does well: The service users spoken to said they were well cared for and other comments included “I’m happy here”, “I like the staff ‘cos they’re young and know what I like”, “the staff help me to do more things”, “staff are great” and “I can do more things for myself now”. The service users have an excellent quality of life with staff putting them at the centre of everything they do. They are supported to try out different activities and go out to cafes, shops, cinema, discos, markets and to go on holiday. As the number of staff starting and leaving the service is low, the service users are able to get used to the staff who support them and it was clear that the service users trusted them. Each service user needed different help and support and the care plans showed clearly exactly what each person could do for themselves and what they needed support with. They also had goals to work towards and staff supported the service users in working towards meeting their goals which had made them able to do more things for themselves. Teamwork was good, with staff sharing and passing on information at staff handovers and meetings so that the service users were supported in the same way by all the staff. Staff were given encouragement by the owners to attend training courses which have made them understand more about working with the service users. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 6 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. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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 Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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&3 The admission procedure was good and service users receive a full assessment, before moving into the home, ensuring their health, social, emotional and personal care needs can be met. EVIDENCE: Whilst the assessment standard was covered at the last inspection, since that time a new service user had come to live at the home and checks were made on this visit to ensure assessment documentation was in place for her. A comprehensive assessment had been undertaken by the care manager and from this information, a care plan had been drawn up in consultation with the service user. In addition, staff were formulating their own assessment and this was being added to as and when they acquired new knowledge about the service user. Feedback from the staff and residents indicated the new service user had settled in well. Staff were seen to be responsive to the requirements of individual service users, who confirmed their needs were responded to willingly by the staff team. Staff received appropriate training to equip them to work with this specialist group of service users, and, due to the small cohesive team, continuity of care was good. Staff demonstrated a high level of commitment to ensuring the needs of the service users were being met. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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 Care plans were detailed, accurately reflected each service users changing needs, choices, goals and support requirements, thus ensuring service users were supported to increase their independence, self-esteem and ability to make informed choices within a safe environment. EVIDENCE: The home had an effective care planning system in place, which incorporated monitoring and reviewing arrangements. The initial assessments formed the basis of the plans. All 4 plans were looked at. The plans identified service users strengths and needs and achievable short and long term goals had been formulated. Two of the service users spoken to said they were fully involved in goal setting and that each day, the staff on duty looked at which goals they had achieved. A more detailed review of the goals was done on a monthly basis and records seen confirmed this was the case. Staff were mindful that the goals should be achievable and where it was identified service users were struggling to meet their goals, they were broken down into more easily achievable tasks or reviewed accordingly. Each service user had a copy of their individual goals in their bedrooms so that they could easily see when they had met them. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 10 Any restrictions on choice or freedom were recorded and detailed risk assessments and behavioural/management strategies were in place. Service users who could sign their plans and risk assessments had done so and from discussions, it was clear that the service users were fully involved in the care planning process. All documentation had been reviewed and updated on a regular basis. Challenging behaviour was monitored and recorded in order that staff could establish whether there were any triggers or particular patterns leading up to behavioural issues. Although the staff team is small, a key worker system is in operation and continues to work well. It was evident from speaking to service users that positive, trusting relationships have been formed with the staff. Care planning reviews are taking place irrespective of whether there is care management input. Review minutes were seen on the files and showed that the service user, key worker, manager and any other interested parties were invited to attend. The staff have a high level of commitment towards motivating service users and were clearly aware of the individual needs of each person. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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): 12 & 17 The staff team afforded service users opportunities to take part in age appropriate activities, which had increased their self esteem and enabled them to meet individual aims/goals. The dietary needs of service users are well catered for with a balanced and varied selection of food, which meets individual tastes and choices. EVIDENCE: The staff are constantly seeking out new opportunities for service users to make sure they have fulfilling and meaningful lifestyles. Clearly, there are limitations on what education/employment opportunities there are as each of the service users has very differing abilities. It was however, evident, from speaking to 3 of the service users that they are satisfied with their current daily routines. Prior to coming to live at Apsley House, one person had attended a day centre five days a week and it was her choice to continue to go there, after moving into the home. A work placement had been arranged for this person, by the centre, which was due to start in January 2006. Another person had a Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 12 voluntary job two days a week in a charity shop. She was clearly pleased with the independence this afforded her and enjoyed meeting new people there. Another service user was going for job interviews as one of her goals was to find a job. Staff were continuing to identify possible new ventures for the other service user to participate in but were mindful these would have to be introduced slowly. One resident was very proud of having successfully completed in-house training in respect of food hygiene. All four service users had completed the training and the staff had issued certificates to them. Staff were encouraging two service users to enrol on a cookery class at college which would start in January 2006. A computer had also been purchased for the use of the service users. Without being regimental, staff encouraged each individual to have structure to their day and a variety of community based activities were being offered. One person attended a sports centre where she had an opportunity to play football, basketball and do trampolining. Other activities enjoyed included shopping, visiting local markets, swimming, attending the Gateway club, circus skills, and socialising with friends. Service users had opportunities to be involved in menu planning, laying and clearing away tables and washing up. One service user described how once a week, all the service users would meet with a member of the staff and discuss what they wanted to see on the menu for the following week. She said the staff considered all the suggestions, which would then be agreed and written into a menu plan. One service user said how much she was enjoying being given the opportunity at least once a week, of cooking an evening meal with very minimal support. The staff spoken with said they were mindful that the service users should eat healthily and they advised accordingly. This was reflected on the menu sheets where it was noted that more home cooked meals were now being made rather than convenience foods. The home had several recipe books and staff and service users were trying out different meals. Where service users had specific nutritional needs, these were assessed and regularly reviewed. Takeaways were clearly enjoyed and these would be offered, sometimes on a weekly basis. Meals out were occasionally planned, but more informal settings were said to be enjoyed i.e. pub snacks or going to cafes. Evening meals were seen as a social occasion with service users and staff eating together. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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 The support provided is effective in improving the physical and mental health and wellbeing of the service users with their preferred routines being followed. EVIDENCE: Staff spoken to were clearly knowledgeable about each service users support needs and preferred routines. As the service user group are all female, there is only one male support worker employed. In order to ensure that difficult situations do not arise, he does not undertake any sleep shifts where he would be alone in the house with the service users. The service users currently living at Apsley House are very independent in personal care and only require prompting to have baths, showers and getting dressed etc. Times for getting up, going to bed, meals and other activities are flexible dependent upon the individual’s weekly activity programme. At weekends, service users said they could go to bed later and have a lie in. Service users received additional specialist support and advice as needed from health care professionals i.e. psychiatrist, district nurse, epilepsy nurse etc. All visits made are recorded on the individual’s file. Any medical advice is recorded in the individual’s care plan. Where concerns are identified with regard to nutrition, service users weight is recorded regularly and carefully monitored. Good weight loss had been recorded for one service user who, Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 14 since moving into the home, had lost approximately 2 stone through a healthy eating plan. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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): 23 The staffs’ knowledge and understanding of adult protection issues provides a safe environment to protect service users from abuse. EVIDENCE: Since the last inspection, the owners of the home, one of whom was the manager, had attended Rochdale Social Services vulnerable adult training and the staff had received in-house training. A support worker had also attended. In addition, the majority of the staff had either completed or were currently on the Learning Disability Award Framework (FDAF) course where aspects of abuse, vulnerability, reporting and types of neglect were covered. The home’s in-house abuse procedure had been amended and was now a more explicit document. From discussion with the staff, it was identified that in the main, they were clear about the procedures to be followed should abuse be suspected although the stages when Social Services should be informed were a little unclear. In order to ensure that all staff are clear about the stages of an investigation, it should be further discussed at staff meetings. From checking care plans, good practice was noted in relation to risk assessments being in place for the vulnerability of service users. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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 The standard of furnishing and fittings within the home was good providing a homely, safe, well adapted, clean and comfortable environment for service users. EVIDENCE: The house is a large terraced providing a good-sized en-suite bedroom for each service user. Two lounges are provided, one of which is designated for smoking. The house was clean, comfortable, bright and airy and the layout enabled service users to have space without having to use their bedrooms. The premises are in keeping with the local community and close to the local amenities of Heywood centre. The owners have an annual maintenance plan and budget. From recordings seen, it was identified they were on line to achieve their aims. A new carpet had been fitted in the smoking lounge, two bedrooms had been re-decorated with full involvement of the individual service users and a new shower had been installed in one en-suite unit. In addition, new bedding, crockery, computer, garden furniture and barbeque had been purchased. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 17 Prior to registration, the requirements of the local fire service and environmental health department were met but no further inspection visits from these bodies have since been made. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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): 32, 33 The staff team had the collective skills, training and expertise to undertake their roles efficiently and effectively which ensured the needs of the service users were being well met. EVIDENCE: From interviewing staff and training records seen, it was identified that whilst the team was small, there was a good match of well-qualified staff, offering consistency of care within the home. Staff from the other 2 homes, were occasionally utilised to provide additional cover for vacancies, leave or sickness. Staff morale was high resulting in an enthusiastic workforce that worked positively with service users to improve their whole quality of life. Staffing levels were currently meeting the needs of the individual service users. This was evidenced from checking the communication book, care plans and staff rotas, as well as talking to staff and service users. Staffing levels reflected what individual service users had planned to do on a daily basis. Discussion with staff, identified they worked well together as a team. Team meetings were regularly held, as were service user meetings. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 19 All the staff team were able to communicate effectively with the service users and good relationships had been formed between them. This was evidenced throughout the inspection. The staff team comprised of 5 permanent support workers and the manager, although on occasions, as stated above, staff from the other houses were used to provide cover. Of the home’s 5 permanent staff, 1 person had successfully completed her NVQ level 3 award and was awaiting certification, 1 person was half way through the training and two others were just starting their NVQ Level 2 training. This means that when the staff have completed their training courses, the home will have more than achieved the 50 ratio. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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 & 42 Service users benefited from a well run home, but the Commission for Social Care Inspection are waiting to receive the managers’ application form in order the administrative process may be finalised. Care practices within the home promoted and safeguarded the health, safety and welfare of the service users. EVIDENCE: Since the last inspection, the registered manager of Apsley House had transferred to another of the Providers’ homes. One of the owners, who was currently joint manager at their home in Bury, is currently in the process of completing an application form to be approved to manage Apsley House. The Commission for Social Care Inspection have not yet received her application, but were informed that it would be submitted immediately. The home has continued to be well run during this transitional period with the manager being supported by the other provider, the previous manager and the Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 21 staff team. The chain of 3 homes, share the managers’ skills and expertise in a collective way in order to improve the services they manage. The new provider/manager has completed her Registered Manager’s Award and undertaken other relevant training. She is currently enrolled on the LDAF level 4 training course in working with people with challenging behaviour, which is currently being piloted. The owners have continued to address all requirements and recommendations, made in their inspection reports, within the given timescales and shown a willingness to work co-operatively with the Commission for Social Care Inspection. All necessary maintenance and associated checks had been made in relation to equipment within the home, and fire drills and alarm tests were being conducted regularly. However, although the central heating system had been serviced in April 2005, the temperature within the home was cool in places, even though the central heating was switched on. The smoking lounge and office were particularly cool and action must be taken to have the system checked by an approved contractor. The staff training programme and training records seen, showed that the staff team were receiving all the necessary health and safety training including: moving/handling, infection control, fire, first aid and food hygiene. In-house risk assessment training had also been undertaken. The majority of the above training was undertaken externally as part of the Learning Disability Award Framework (LDAF) training and then in-house refresher training was done as necessary. Fire training had been held for the staff team on 1 November 2005. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 4 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Apsley House Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000058327.V266118.R01.S.doc Version 5.0 Page 23 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. 1. 2. Standard YA37 YA42 Regulation 8 23 Requirement An application for the registered manager post must be submitted. A room thermometer must be fitted in the smoking lounge in order that staff can monitor the temperature does does not fall below 20°c. Timescale for action 31/12/05 31/12/05 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 YA23 Good Practice Recommendations The manager should ensure that all staff are clear about what steps to follow should an incidence of abuse be identified. Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Apsley House DS0000058327.V266118.R01.S.doc Version 5.0 Page 25 - 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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