Care Home: Apple House

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What the care home does well Apple House provides a homely environment for the people living there and appropriate activities and meals. All residents said they liked living at the home and that there was a high standard of care given. `I think that the staff are good and we like living here,` one resident said. We looked at care records and they showed staff making every effort to respect residents wishes. For example one resident said he was able to go out when he wanted and go to the local shops. Residents have the opportunity to take part in their own agreed activities including trips out - shopping, pubs, clubs, colleges, day centres etc. The home cooked food is liked by residents. There is a wide range of fresh fruit and vegetables and an emphasis on healthy eating. All the residents we spoke to praised the food they had. The staff team is established. This means residents have the opportunity to get to know the people who care for them. Staff were seen to be friendly and helpful to residents and the Manager was praised by residents. What has improved since the last inspection? The service continues to provide quality care to residents. What the care home could do better: Monies records need to be signed by staff so that they can be properly checked if a query arises. Satisfaction questionnaires should be retained so residents views on the running of the service can be checked if needed. The decor in residents bedrooms could do with review in the medium term to ensure it remains attractive to people. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Apple House 16/22 Bushloe End Wigston Leicestershire LE18 2BA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Charlton     Date: 1 0 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Apple House 16/22 Bushloe End Wigston Leicestershire LE18 2BA 01162888028 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Joanne Archbold care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: No additional conditions of registration. Date of last inspection Brief description of the care home The last key inspection of the service was on 12/7/2007. Apple House is a small care home providing personal care for people with learning disabilities in the Wigston area of the City of Leicester. All residents have their own bedrooms, which are personalised and homely. There is a kitchen and dining room and a separate lounge. Residents also have access to the back garden. All residents attend outside work during weekdays and enjoy these activities. The fees at the time of this inspection ranged from #334 to #351 per week. There are additional costs for individual expenditure such as hairdressing, toiletries, holidays etc. Information about the home including the statement of purpose and the service users Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 8 Brief description of the care home guide can be obtained from the Manager. Care Homes for Adults (18-65 years) Page 5 of 27 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: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit we, the use of we indicates the Care Quality Commission, spent time reviewing information relating to the home, including the last key Inspection Report and the Annual Quality Assurance document that describes the services the home offers. During the course of the inspection, which lasted three and a half hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to two residents living at the home, by meeting them, talking with the staff Care Homes for Adults (18-65 years) Page 6 of 27 who support their care, checking records relating to their health and welfare and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home including health and safety and management issues were examined. We also talked with four residents, the Manager and two care staff. We received surveys back from seven residents and one staff member. All testified to the high standard of care the service provides. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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 27 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 27 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. People living at Apple House have had their needs properly assessed before moving into the home. Evidence: We case tracked a person living in the home. We checked that he had received information to help him with the choice of home, but because the person could not recall it was not possible to check he had received this. The Manager stated in the AQQA that there have been no new admissions of residents for many years but a proper assessment will be done in the future as needed. We also checked that the person now living at the home had their needs properly assessed prior to moving to Apple House to ensure that the staff at the home could meet their needs.We found this to be the case as the Social Services assessment covered all important issues such as health, behavior, relationships, medication, sleeping, work and play, personal hygiene, safe environment etc. Care Homes for Adults (18-65 years) Page 10 of 27 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 individual needs and choices of each person living at Apple House are well documented and acted upon by staff. Evidence: Residents could not remember having care plans though there was evidence that they/their relatives were involved in the reviews of plans as they had been signed. We looked at the care records of two people living at Apple House. We found very detailed plans to support the care given to people who live at the home. There was a variety of useful information available to staff - Health Action Plans, Weekly recording of what went on in residents lives, and records of contacts with medical services. There are also a number of risk assessments so that residents can be protected from all identified risks. Care Plans also contain detail as to how to encourage residents independence keeping their bedrooms tidy, helping in the kitchen, self medication, doing their pack up lunches etc. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: One resident said: We like to be independent and I can do that here. I can go out when I want and use the bus on my own. During our visit we observed staff being very friendly to residents and joking with them. There was some evidence that residents are able to live their own lives, e.g. going out to places in the community, choice of meal, choice of activities etc. Care Homes for Adults (18-65 years) Page 12 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Apple House have lots of opportunities to have a varied lifestyle of their choice. Evidence: Residents said that they were happy doing their activities: We do lots of things like going to college, swimming club, Gateway and Mencap things, we go to the Legion and to church, one resident said. There was evidence in records that people are encouraged to have contact with their relatives and residents talked about this as well. We looked at the plans of people who live at Apple House. People go to work at the gardening centre or day centre activities during the day. One resident works for two days a week. There is college to learn life skills, and others have a variety of activities in the community to choose from and are busy most evenings of the week. Residents have annual holidays and are going to Blackpool this year and all residents said they Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: were looking forward to this. We saw that staff are sensitive to the needs of people living at the homes. They were aware of the preferences of people in their daily activities. We saw staff talk to and interact well with people. All residents said they enjoyed the homes food. We saw tea being served and people having a meal of quorn mince with vegetables, which residents said they enjoyed. Menus were in place and showed good variety of fruit and vegetables on offer. Residents all have the same main meal though alternatives are shown if they want something different. The meal portion sizes were of good portion, which residents said they liked. Care Homes for Adults (18-65 years) Page 14 of 27 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. People who live at Apple House receive good support to meet their personal and healthcare needs. Evidence: Residents said that staff call in the GP if they are not well. A resident told us of going to the hospital to have some tests and going to see the nurse to have his blood pressure checked. We looked at the personal and health care records of people who live at Apple House. We saw that they have good access to health care services to meet their personal and health care needs as described in individual Health Action Plans. They also have access to other nursing services and they have an annual health check. We looked at the records and found that staff act quickly on concerns about peoples needs, and these actions have resulted in a better quality of life for those concerned. We looked at medication management and found that residents self administer their own medication with staff support and there is information on file as to what the medication is for and side effects etc, as well as important information on medical Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: conditions, allergies etc. Care Homes for Adults (18-65 years) Page 16 of 27 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. People at Apple House can be confident that their concerns would be acted upon, and they are protected from abuse. Evidence: Residents said that if they had a problem they were sure that Joanne, the Manager, would sort it out for them. We dont need to complain but if we did it would be sorted, one resident said. We looked at the complaints procedure. The procedure gives the complainant the choice to go directly to the Lead Agency if they wish, instead of the home, though the Lead Agency was recorded as the Care Commission, not the local Social Services Department. The Manager said this would be altered. The Manager also that there have been no complaints since she took over as the owner of the home and we have had no concerns reported to us. We saw by looking at staff training records, and by talking to staff that staff have a good understanding of safeguarding policies and procedures. Staff know what to do if they suspect that a person who lives in the home is being abused. People who live in the home have their own bank accounts. Staff support people living at The Meadows in dealing with their money. We checked the financial records of a person living at the home, and found good recording of money transactions apart from the need for staff to sign for all money transactions, which the Manager said would be Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: followed up. Care Homes for Adults (18-65 years) Page 18 of 27 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. People living at Apple House live in a homely, comfortable environment. Evidence: We looked at the communal areas of the homes and some of the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and homely. The bedrooms were decorated and furnished to reflect the personalities and preferences of the people using them. The AQAA told us that the home is comfortable, homely, safe and clean and hygienic and residents are happy with the facilities. Residents showed us their bedrooms and said that they liked having all their things in them and that they could have drinks when they wanted. Apple House was found to be clean with no malodours.We looked at the communal areas of the home and some of the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and homely. The bedrooms were decorated and furnished to reflect the personalities and preferences of the people using them. The AQAA told us that the home is comfortable, homely, safe and clean and hygienic and residents are happy with the facilities. We saw that the home was well maintained in general. Some bedrooms looked like they may need to be redecorated in the medium term as they were showing signs of Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: wear. Care Homes for Adults (18-65 years) Page 20 of 27 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. People who live in Apple House benefit from satisfactory staffing levels and support from a motivated staff team. Evidence: Residents said they liked the staff and saw them as their friends, All the staff are good and we can get help from them if we need it, one resident said. Residents thought the home was properly staffed and said it wasnt a problem being able to speak to staff at any time. The staff rota indicated that when all residents were in the home, there were a minimum of two care staff on duty with a sleeping in staff member at night and an on call system. We talked to staff and saw them supporting people who live in the home. We saw good interaction between staff and people who live in the home, and staff demonstrated a good understanding of the needs of people living there. There was evidence that staff were supported to do their job by management, and there was evidence of induction training with the Manager saying that she would use the recognised Skills for Care induction manual for new staff in the future. We saw staff had done on going training relating to the job they do, with regular informal supervision. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: We found that one care staff has a National Vocational Qualification in Care with the Manager having a NVQ 3.She is also a trained Nurse. We looked at some staff records, and saw that all the necessary checks were made to safeguard people who live at the home. Care Homes for Adults (18-65 years) Page 22 of 27 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. Health and safety systems are in place to protect residents welfare. Evidence: Jo Archbold is the Manager and Co owner of the Home. Jo is a qualified Nurse and has a NVQ 3 in providing care, to assist her in having the skills to run a home in the best interests of residents. There was an analysis of feedback from residents from the homes quality assurance questionnaires stating that all residents are content with the service - however the surveys themselves had been disposed of. The Manager said she would keep them in future so they can be looked at by any interested party. The AQAA informed us of the policies and procedures the service works to, to ensure good health and safety practice in the home. The temperature of water was checked and within range to ensure residents are protected from scalding water, and we saw a risk assessment regarding hot water in residents care plans. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Risk assessments are in place for safe working practices and fire risks were seen to be covered by regular testing and a fire risk assessment in place. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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