Care Home: Apple Blossom Court

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What the care home does well The people who come to live at Apple Blossom Court have their needs met by the way in which the service plans their admission to the service, the way that all individuals involved in their care are consulted and the way in which information is provided to all concerned. The people who live at Apple Blossom have their needs met by the way the service has devised care plans outlining their needs and the way in which the person, their families and other relevant people are involved in their review. People are able to make decisions about their lives and have any risks that arise as a result of these decisions taken into account by the service. People who use the service are able to pursue occupation and education as they wish and all are able to access the local community with support from staff. People are able to maintain contact with their family and friends and have their rights respected. The service maintains the nutritional needs of people and ensure that people maintain their independence in eating. The people who use the service are supported in the manner they wish and are able to maintain their independence. The health of individuals is promoted through the way the service takes their health needs into account. People`s health is further promoted by the safe management of medication. The people who use the service and their families have the information they need in order to raise concerns about the quality of support being received. People are protected from abuse. Apple Blossom Court provides a well maintained and hygienic environment for those who live there. The people who use the service are supported by staff who are trained to meet their needs and who have been recruited appropriately. People are protected by the recruitment process. People who use the service receive support from a staff team that are managed by an experienced and qualified individual although the provider has not forwarded a candidate to become the permanent registered manager. People who live at Apple Blossom Court and their families are able to influence the running of the service through the service`s quality assurance process. The health and safety of individuals is promoted. Comments received as a result of our visit included: `I have settled down here` `It is alright` I feel safe here` `The Manager does all she can` `I get a choice in what I want to do and where I want to go` `If I had a problem I would go to the staff-they listen to me` `The Manager would sort any problems out` `I can see a Doctor when I want to` `We have enough staff here` `The Manager is good and supportive` `I do not think the place can improve` `The best thing is that the staff and residents get on so well` The Annual Quality Assurance Assessment completed by the service considers that it does the following well: The Care Manager works full time and is committed to offering a good service, she is practically involved in the day to day running of the home and in all areas of the residents lives. The Care Manager has a good working relationship with the staff team, residents and visitors to the home and is supportive and approachable, she listens to concerns and takes them seriously. The PCCP with Risk Assessments are detailed and support the staff team to offer the best type of care and support to service users. The home has had some changes to the staff team and does not use agency staff to provide the residents with consistency and continuity of care. The Care Manager ensures that other professionals are involved in the residents lives to ensure they receive the best possible support to meet their individual needs. The Care Manager has provided a pictorial questionnaire and Complaints Procedure with the residents to enable them to make the views known. The residents are supported to choose who supports them to complete documents. What has improved since the last inspection? No requirements were raised during our last visit but there were a number of good practice recommendations raised. These had been addressed with the exception of one relating to the status of the acting manager in relation to registration with ourselves. The Annual Quality Assurance Assessment completed by the service considers that the following has improved: We have sort opinions regarding the running of the home from residents and acted upon their comments where appropriate We have purchased new training materials and following Policy and Procedure reviews have updated where necessary We have updated our Physical Intervention Policy in line with Wirral Social Services advice and with the support of the CSCI inspector at the last inspection at our sister home Residents have been involved in reviewing the new document they created for them to us to express any concerns they may have if the staff are unable to resolve any issues they raise The residents have requested that they be known as residents and not service users and this has been acted on What the care home could do better: A number of good practice recommendations are raised in this report. One recommendation remains outstanding from the previous visit in respect of management. The Annual Quality Assurance Assessment completed by the service considers that the following could be better: Always strive to improve the service we offer and include as many opinions as possible. Ensure we obtain the latest information to support our service users in all aspects of their lives and maintain up to date training. Key inspection report Care homes for adults (18-65 years) Name: Address: Apple Blossom Court 1 Falkland Road Wallasey Wirral CH44 8EN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Paul Kenyon     Date: 2 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Apple Blossom Court 1 Falkland Road Wallasey Wirral CH44 8EN 01516370988 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Noemail Apple Blossom Lodge Limited care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief description of the care home Apple Blossom Court is a small care home that is registered to provide personal care and support for up to 17 adults with a learning disability. The home is a large detached property that has been extended. The property is situated in a residential area of Wallasey, close to local shops, community facilities and bus routes. Bedrooms are located over three floors and are all single rooms. There is a separate dining room, a large communal lounge and an activity room on the ground floor. The home does not have a passenger lift. To the rear of the home there is an enclosed patio/garden area that is accessed through patio doors in the main lounge or through the kitchen door. Fees are dependent on the level of support required by each person. 17 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of Apple Blossom Court. The service did not know that we were going to visit. The visit took started in the morning and extended into the afternoon. During the visit, we looked at a number of records relating to the care provided by the service. We also toured the building and spoke with people who use the service and members of the staff team. We also sent surveys out to people. The service returned an Annual Quality Assurance Assessment (known as an AQAA) when we asked them to and this provided additional information. We used the AQAA to form our judgements about the service. Care Homes for Adults (18-65 years) Page 5 of 26 What the care home does well: The people who come to live at Apple Blossom Court have their needs met by the way in which the service plans their admission to the service, the way that all individuals involved in their care are consulted and the way in which information is provided to all concerned. The people who live at Apple Blossom have their needs met by the way the service has devised care plans outlining their needs and the way in which the person, their families and other relevant people are involved in their review. People are able to make decisions about their lives and have any risks that arise as a result of these decisions taken into account by the service. People who use the service are able to pursue occupation and education as they wish and all are able to access the local community with support from staff. People are able to maintain contact with their family and friends and have their rights respected. The service maintains the nutritional needs of people and ensure that people maintain their independence in eating. The people who use the service are supported in the manner they wish and are able to maintain their independence. The health of individuals is promoted through the way the service takes their health needs into account. Peoples health is further promoted by the safe management of medication. The people who use the service and their families have the information they need in order to raise concerns about the quality of support being received. People are protected from abuse. Apple Blossom Court provides a well maintained and hygienic environment for those who live there. The people who use the service are supported by staff who are trained to meet their needs and who have been recruited appropriately. People are protected by the recruitment process. People who use the service receive support from a staff team that are managed by an experienced and qualified individual although the provider has not forwarded a candidate to become the permanent registered manager. People who live at Apple Blossom Court and their families are able to influence the running of the service through the services quality assurance process. The health and safety of individuals is promoted. Comments received as a result of our visit included: I have settled down here It is alright I feel safe here The Manager does all she can I get a choice in what I want to do and where I want to go If I had a problem I would go to the staff-they listen to me The Manager would sort any problems out I can see a Doctor when I want to We have enough staff here The Manager is good and supportive I do not think the place can improve The best thing is that the staff and residents get on so well Care Homes for Adults (18-65 years) Page 6 of 26 The Annual Quality Assurance Assessment completed by the service considers that it does the following well: The Care Manager works full time and is committed to offering a good service, she is practically involved in the day to day running of the home and in all areas of the residents lives. The Care Manager has a good working relationship with the staff team, residents and visitors to the home and is supportive and approachable, she listens to concerns and takes them seriously. The PCCP with Risk Assessments are detailed and support the staff team to offer the best type of care and support to service users. The home has had some changes to the staff team and does not use agency staff to provide the residents with consistency and continuity of care. The Care Manager ensures that other professionals are involved in the residents lives to ensure they receive the best possible support to meet their individual needs. The Care Manager has provided a pictorial questionnaire and Complaints Procedure with the residents to enable them to make the views known. The residents are supported to choose who supports them to complete documents. What has improved since the last inspection? What they could do better: A number of good practice recommendations are raised in this report. One recommendation remains outstanding from the previous visit in respect of management. The Annual Quality Assurance Assessment completed by the service considers that the following could be better: Always strive to improve the service we offer and include as many opinions as possible. Ensure we obtain the latest information to support our service users in all aspects of their lives and maintain up to date training. Care Homes for Adults (18-65 years) Page 7 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who come to live at Apple Blossom Court have their needs met by the way in which the service plans their admission to the service, the way that all individuals involved in their care are consulted and the way in which information is provided to all concerned. Evidence: We looked at the information the service obtains about a persons needs before they come to live at Apple Blossom. No one has come to live at the service since we last visited. We did note that there is an admissions procedure in the event of a new admission and this suggested that an new admission into the service is a planned process with the opportunity for people to stay at the service as a trial visit and a process of review being available involving all the people who are involved in the lives of the individual. Te service has improved its information it provides to people. The statement of purpose and service users guide has been produced a in symbolic and picture format tailored to the needs of individuals. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Apple Blossom have their needs met by the way the service has devised care plans outlining their needs and the way in which the person, their families and other relevant people are involved in their review. People are able to make decisions about their lives and have any risks that arise as a result of these decisions taken into account by the service. Evidence: We looked at four care plans relating to people who currently use the service. Care plans are reinforced by daily accounts of the progress of individuals and the type of staff interventions that have occurred. These interventions focus on daily living skills such as domestic tasks or personal care skills in relation to individuals maintaining their own personal hygiene and appearance. Of the care plans sampled, all had been reviewed during August and September 2009. These reviews include people who are significant in the lives of each person including their families, health professionals and staff members. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: We looked at the way in which people where enabled to make decisions about their lives. We interviewed three people. In all cases, people confirmed that they felt they could make decisions about what they wanted to do and this included what activities they could do during the day. They also confirmed that staff ask their views on the quality of support they received through resident meetings which are held periodically. They also confirmed that they could get access to their finances whenever they needed. All individuals have bank accounts yet these tend to be managed by their families. The service does have a role in the safekeeping of peoples monies and offer a secure and accountable system for this. No one uses an advocate at the moment although their is information in the service users guide providing information about what an advocate does and where they can be contacted. We looked at the way in which the service assesses the risk faced by people in their daily lives. Any risk assessments are included within care plans and these in turn are reviewed. These reviewed are made in agreement with the persons family as well as with the involvement of the individual. The four risk assessments we looked at were all reviewed in August and September of this year. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to pursue occupation and education as they wish and all are able to access the local community with support from staff. People are able to maintain contact with their family and friends and have their rights respected. The service maintains the nutritional needs of people and ensure that people maintain their independence in eating. Evidence: There was evidence through interviews with people and daily records during the visit that people either attend local day services or are supported to be involved in some form of voluntary work. This related to two people. For others, an activities programme is available although this tends to be flexible in nature and activities on display in the lounge area serves as a general guide. There was evidence of activities for all through records which outline day to day activities such as visiting the park or going shopping as well as attending local events. All included evidence of being Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: supported by staff to do this. Interviews with people confirmed that they do get out with differing levels of staff support and can choose where they go. They also confirmed that they have bus passes. There was other evidence of holiday activities further afield. For others, activities tend to occur with staff support and these people do not necessarily attend structured day services or occupation but follow their activity plan. During the visit there was evidence that all people were able to access the local community to some degree and that everyone had had the opportunity to experience some form of activity in the community that day. Interviews with three individuals confirmed that they have contact with their family and friends and that they visit. Care plan files included reference to when family members have visited their relation and the amount of contact that they have had with them. Relatives were involved in the reviews of the four care plans sampled during our visit. During our tour of the building, we were invited to view a sample of bedrooms. The Acting Manager ensured that no one was present in their room before we entered and knocked on the door to ensure this. No keys have been offered to people and this is reflected in risk assessments.Staff were noted to interact with individuals in a friendly and supportive manner. There is provision within the building for individuals to spend time on their own in their bedroom or in a quiet lounge located on the upper floor of the building. During our visit, it was noted that people tended to congregate together in lounge areas. Individuals were able to access all parts of the building without restriction. During our visit we noted that individuals participate in household tasks and this is recorded within care plans as daily living skills. There is a facility on the upper floor of the building which serves as a flat with domestic appliances for individuals to practice their skills in this. Daily records provided evidence of people participating in domestic tasks through each day. A menu is available over a four week period but this tends to be flexible and serves as a guide. The service maintains a record of food provided which reflects the actual meals served to people. People are involved in some shopping for smaller food items using local shops but no one actively assists in preparing a meal due to their disability. Individuals are involved in tasks such as setting tables and drying/washing dishes. All people interviewed stated that they enjoyed the food provided and that choices were available. There was evidence that some people require specialist diets and meals are provided for these individuals. There was evidence that individuals receive support from speech therapists in relation to swallowing and that occupational therapists have Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: provided information on specialist cutlery, plateguards and beakers to enable people to eat and drink independently. Any nutritional needs are included within care plans. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported in the manner they wish and are able to maintain their independence. The health of individuals is promoted through the way the service takes their health needs into account. Peoples health is further promoted by the safe management of medication. Evidence: We interviewed three people. All stated that they felt that the staff team were helpful and listened to their views. Care plans suggested that an emphasis is placed on individuals doing as much for themselves as they could as opposed to staff doing things for them. This was evidenced through the personal hygiene tasks they followed and how they progressed with this. This also extended to them pursuing daily living tasks such as involvement with domestic tasks. The personal appearance of individuals is also taken into account with information on clothes sizes and which hairdresser they had chosen to assist in maintaining their appearance. There was evidence through care plan reviews that families were involved in the support of their relations and that this support extended to the involvement from other health professionals. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: We looked at how peoples health is promoted. We looked at four care plans. Included in this were details of health appointments that people had attended and the outcome of each appointment. Records suggested that people are reliant on the staff team to arrange appointments. There was evidence in records of people attending Doctors appointments, opticians, chiropodists, speech therapists and occupational therapists. Health action plans had been devised which included details of the specif health of individuals and action to be taken to ensure peoples health is maintained. There was evidence for all that people are provided with annual health checks which identified specific health needs and resulted in further investigation through hospital appointments. There was also evidence of a continence nurse being involved and District Nurses are used when needed. We interviewed three people. All stated that they felt well at present but were provided with the chance to see a Doctor if they did not feel well for any reason. We looked at the way the service manages medication. No one self administers at present and the staff team have taken responsibility to assist people with medication. Medication is stored in purpose built cabinets within a room that is locked when not in use. No controlled medications are prescribed at the moment. Records are in place for the recording of medication when it has been administered. These were found to be appropriately signed. There was evidence that when medications were received by the service, that signatures were present to confirm the amount of medication received. Records were also in place to confirm when medications were returned to the pharmacy supplier. Training records suggested that staff had received training in handling medication. The Acting Manager stated that the pharmacy supplier had visited on occasions to check the safety of the medication system within the service. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and their families have the information they need in order to raise concerns about the quality of support being received. People are protected from abuse. Evidence: The complaints procedure has now been developed in pictorial form and is included within the revised statement of purpose and service user guide. A copy of the complaints procedure is on display in the hallway. We interviewed three people. We asked if they knew who to complain to. All stated that they were happy with the service but they would talk to staff or the manager. The service maintain a record of complaints yet no complaints have been received by the service since the last time we visited in 2008. The service has a copy of the Local Authority safeguarding reporting procedure as well as its own policy. We interviewed staff about training they had received. In all cases they stated that they had recently received training in safeguarding adults and had an understanding of the whistle blowing procedure. In addition to this, the service has policies in relation to the receipt of gifts and involvement of staff in the finances and wills of individuals. It was noted that some individuals do occasionally display a degree of verbal aggression although this is not a common occurrence. Guidelines are in place for how staff would deal with this and strategies are in place for physical intervention. No allegations of abuse have been made since our last visit and the acting manager is Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: aware of how staff should be referred to the safeguarding authority. This has not been needed since our last visit to the service. Care Homes for Adults (18-65 years) Page 19 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Apple Blossom Court provides a well maintained and hygienic environment for those who live there. Evidence: We toured the building. The service operates from a building located in a residential area of Wallasey which is close to local community facilities and bus routes. It is not distinguishable as a care home. The tour noted that the interior of the building is well maintained and well decorated. Maintenance staff are available to address small repairs in the building and to undertake some redecoration when needed. Refurbishment of the property is ongoing and takes place when needed. All other repairs are undertaken by contractors when required. Areas viewed during our visit were noted to be maintained to a good standard and appeared to be free from hazards. The home was clean and tidy and there were no offensive odours. We viewed a number of bedrooms and these had been decorated and personalised to the choice and tastes of individuals. Care Homes for Adults (18-65 years) Page 20 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported by staff who are trained to meet their needs and who have been recruited appropriately. People are protected by the recruitment process. Evidence: We interviewed three members of staff. They stated that they had received training in a number of mandatory topics including manual handling, food hygiene, infection control, first aid and the protection of vulnerable adults. All staff also confirmed that they had all attained a National Vocational Qualification at Level 3. Training records were available. These suggested that as well as mandatory health and safety topics, staff had received training in topics such as protection of vulnerable adults, challenging behaviour, effective communication, principles of person centred care and whistleblowing. In addition to this there had been training provided in specific conditions relating to individuals such as epilepsy, continence and diabetes. There was evidence that new staff now follow a more structured induction process. New starts commence a process using Common Induction Standards. After this is completed, staff then have the opportunity to commence a National Vocational Qualification at Level 2. This process was evidenced in the two personnel files we looked at. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive support from a staff team that are managed by an experienced and qualified individual although the provider has not forwarded a candidate to become the permanent registered manager. People who live at Apple Blossom Court and their families are able to influence the running of the service through the services quality assurance process. The health and safety of individuals is promoted. Evidence: The Manager is currently in an Acting position and has not applied to us to become the registered manager. This was a recommendation from our last visit and this recommendation is raised again in this report. The Acting Manager has experience in working in residential care and has attained an National Vocational Qualification at Level 4 as well as obtaining the Registered Managers Award. Discussions with the Acting Manager noted that they were clear about the rights of individuals to have access to all the opportunities in life that they are entitled to. We asked staff about the Manager. IN all cases, comments were positive and included: the Manager is very nice and supportive, I have a lot of respect for her and she is good and supportive. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: We looked at the way in which the service examines its own practice. The Acting Manager confirmed that the provider visits on a monthly basis to assess the quality of care provided. All but one of the recommendations raised during our last visit have been addressed and we were given the opportunity to view all records, tour the building and interview people in private. The service last sent questionnaires out to individuals in July 2009. These surveys were sent to individuals, their families and staff. A summary of comments was available and these indicated that all were positive about the care provided. We looked at the way the service promotes the health and safety of people. The service has now obtained a certificate to confirm testing to fire alarms, developed risk assessments and now monitors water temperatures. There was evidence tat fire alarms are tested on a regular basis as well as fire extinguishers. One fire extinguisher did not indicate that it has been serviced. This is raised as a recommendation in this report. Information on the control of substances hazardous to health was not available and again it is recommended that this is obtained. The service records accidents that are sustained and has had its electrical wiring and gas systems checked as evidenced through certificates. Portable appliances have been tested and radiators have been covered and restrictors in situ on upper bedroom windows. Interview with staff confirmed that they had received training in health and safety and this was confirmed by training records and certificates. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 34 A medical declaration form should be made available for the member of staff identified during the inspection to confirm their medical fitness to perform their role. The Registered Provider should submit a candidate to the Care Quality Commission to apply to be registered as the Manager Information on substances hazardous to health should be retained for reference. Evidence to suggest that the fire extinguisher identified during the visit has been serviced should be produced 2 37 3 4 42 42 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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