Care Home: Apple House

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What the care home does well People only move in to the home following an assessment of their needs and aspirations and knowing that the home has the skills to support them. People living in the home are supported to make decisions about their lives. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 People living in the home are able to participate in activities which interest them in the local community. People in the home maintain contact with family and friends. Individual daily routines are respected and people are able to take responsibility. The home enables people to take responsibility for a healthy diet. Person centred plans enable people to be clear about how they need and prefer to be supported. An accessible complaint’s procedures, means people are able to express their views and be listened to. The safeguarding policy and training in place for staff means that they know how to protect people. The home is clean and hygienic. People who live in the home are protected by the homes recruitment policy and practice. What has improved since the last inspection? At the end of the inspection in July 2008 there were five requirements and eight recommendations. To ensure that people’s physical and emotional needs are fully met care workers have the training necessary to support individual health care procedures. Information in an individual’s care and support plan has improved to ensure that the service can evidence that health care needs are being met. The service now employs permanent care staff to ensure individuals have continuity of care. All staff that work in the service now have training in epilepsy, which means they understand how to support someone with this health condition.Apple HouseDS0000063160.V377580.R01.S.docVersion 5.3Care plans are now reviewed monthly and information which is not pertinent to an individual’s current care is archived. This enable staff to provide consistent care based on current information. The risk assessment for one person has been extended to include falling on a hard surface either in the service or out in the community to ensure that all areas of potential risk have been identified. Monitoring records are completed by the person who witnessed the incident to ensure records are accurate. All staff working in the home have received medication training, to ensure they meet the required standard and maintain the safety of people living in the home. There is a training programme in place to ensure that all staff are working towards the appropriate qualifications. Staffing levels are in place to meet the needs of individuals living in the home. The management of the service are aware of the records they need to keep in the home if any agency staff are working a shift. Systems in the home are audited to ensure people are safe. What the care home could do better: At the end of this inspection there are no requirements and six recommendations. When people are recording information in the daily records they should consider the accuracy of the information they are writing and whether it is based on their opinion or fact. To ensure that people’s physical needs are fully met care plans should be clear, for example if someone is to have their blood sugar levels monitored it is important the care plan states the level which is acceptable. The care plan should also state what to do if the check shows the person is either below or above what is acceptable to maintain their health. Where someone is prescribed a cream the care plan should clearly state, how, where, when and why the cream is to be applied, this will ensure the person is receiving the treatment they need. To be able to fully demonstrate that the home is a safe place to live it is important that maintenance records are accurate.Apple HouseDS0000063160.V377580.R01.S.docVersion 5.3To ensure that people’s views are being taken into account the home should ask them their views about practices within the home such as leaving the bedding used by night staff in the lounge. To protect the health, welfare and safety of people in the home the unrestricted window on the landing should be risk assessed and action taken. Key inspection report CARE HOME ADULTS 18-65 Apple House 186 Seafield Road Bournemouth Dorset BH6 5LJ Lead Inspector Tracey Cockburn Key Unannounced Inspection 18th September 2009 09:30 Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 2 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 Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Apple House Address 186 Seafield Road Bournemouth Dorset BH6 5LJ 01202 429093 01202 773410 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) Apple House Limited Mrs Jane Elizabeth Montrose Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to be admitted must be ambulant and able to manage stairs. 31st July 2008 Date of last inspection Brief Description of the Service: Apple House is a residential care home registered to accommodate a maximum of four adults with a learning disability. It is one of two homes owned by Apple House Limited in the Bournemouth area. Apple House is a semi-detached home located in the Southbourne area of Bournemouth. The property is in-keeping with the neighbourhood. It is situated within easy reach of local shops and community facilities. The home has a vehicle which can accommodate all service users. There is on-road parking at the front of the house. Bus routes to the nearby towns of Christchurch, Boscombe and Bournemouth are easily accessed. Accommodation is provided in single bedrooms. Three bedrooms are on the first floor of the property, one of which has its own en-suite facilities. There is one shower room and toilet for shared use by three residents which is also on the first floor. One bedroom is situated on the ground floor. The home has an attractively decorated and furnished lounge, kitchen and dining room area. There is a patio area and garden to the rear of the property for use by residents. The basic fee for service users at Apple House is £735 per week. Further general information about fees and fair terms of contracts may be obtained from the Office of Fair Trading - www.oft.gov.uk . Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out by one inspector but throughout the report the term ‘we’ is used to show that the report is the view of the Care Quality Commission. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the five requirements made at the last key inspection in July 2008. At the time of the inspection there were four people living at Apple House. We visited the home without warning; the site visit lasted five and a half hours. During the inspection we were able to meet three of the people who use the service and observe interaction between them and staff. Discussion took place with the Responsible Individual, Romaine Lawson, and the home manager. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were given to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received three surveys from people who use the service; no surveys from staff and one survey from care professionals who have contact with the home. We received the home’s Annual Quality Assurance Assessment when we requested it which gives us written information and numerical data about the service. This information is used to inform the planning of the inspection. What the service does well: People only move in to the home following an assessment of their needs and aspirations and knowing that the home has the skills to support them. People living in the home are supported to make decisions about their lives. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 6 People living in the home are able to participate in activities which interest them in the local community. People in the home maintain contact with family and friends. Individual daily routines are respected and people are able to take responsibility. The home enables people to take responsibility for a healthy diet. Person centred plans enable people to be clear about how they need and prefer to be supported. An accessible complaint’s procedures, means people are able to express their views and be listened to. The safeguarding policy and training in place for staff means that they know how to protect people. The home is clean and hygienic. People who live in the home are protected by the homes recruitment policy and practice. What has improved since the last inspection? At the end of the inspection in July 2008 there were five requirements and eight recommendations. To ensure that people’s physical and emotional needs are fully met care workers have the training necessary to support individual health care procedures. Information in an individual’s care and support plan has improved to ensure that the service can evidence that health care needs are being met. The service now employs permanent care staff to ensure individuals have continuity of care. All staff that work in the service now have training in epilepsy, which means they understand how to support someone with this health condition. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 7 Care plans are now reviewed monthly and information which is not pertinent to an individual’s current care is archived. This enable staff to provide consistent care based on current information. The risk assessment for one person has been extended to include falling on a hard surface either in the service or out in the community to ensure that all areas of potential risk have been identified. Monitoring records are completed by the person who witnessed the incident to ensure records are accurate. All staff working in the home have received medication training, to ensure they meet the required standard and maintain the safety of people living in the home. There is a training programme in place to ensure that all staff are working towards the appropriate qualifications. Staffing levels are in place to meet the needs of individuals living in the home. The management of the service are aware of the records they need to keep in the home if any agency staff are working a shift. Systems in the home are audited to ensure people are safe. What they could do better: At the end of this inspection there are no requirements and six recommendations. When people are recording information in the daily records they should consider the accuracy of the information they are writing and whether it is based on their opinion or fact. To ensure that people’s physical needs are fully met care plans should be clear, for example if someone is to have their blood sugar levels monitored it is important the care plan states the level which is acceptable. The care plan should also state what to do if the check shows the person is either below or above what is acceptable to maintain their health. Where someone is prescribed a cream the care plan should clearly state, how, where, when and why the cream is to be applied, this will ensure the person is receiving the treatment they need. To be able to fully demonstrate that the home is a safe place to live it is important that maintenance records are accurate. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 8 To ensure that people’s views are being taken into account the home should ask them their views about practices within the home such as leaving the bedding used by night staff in the lounge. To protect the health, welfare and safety of people in the home the unrestricted window on the landing should be risk assessed and action taken. 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. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 9 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 Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are considering moving into the home only do so following an assessment of their needs, which ensures that everyone is clear the home has the skills and staff necessary to meet individual needs and aspirations. EVIDENCE: The annual quality assurance assessment tells us: “When a new prospective resident comes to look around we try and give them a flavour of what it is like to live at Apple House. New residents really get a picture of what it is like to live at Apple House with plenty of information on display that is accessible to them. Detailing events and photos of all the activities that residents participate in. Our new permanent staff team has really put together a client centred approach to the clients and this is really reflected in the service. We have improved our thoroughness of the assessment process making sure that during the transition period we record and document. Our recent new resident has had a comprehensive assessment where his individual programme has been worked out with them including day and night Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 11 time activities.” We looked at the care file for one person who has recently moved into the home, we found there was a care management assessment completed by the funding authority as well as a care plan. We looked at the information in the person’s file which detailed the visits to the home prior to moving in this included an afternoon visit and an overnight stay. The person’s individual care and support plan contained information provided by health and social care professionals in their assessment. The home told us they are planning to: “We will be looking to implement a new transition questionnaire in an accessible format so every new resident can record their journey into their new home and discuss any issues or anxieties that they may have.” Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to care and goal planning means that people know their changing needs are reflected in their individual plans and staff are up to date with changes. EVIDENCE: We looked at the care and support plans for two people who use the service; we found detailed information written in a person centred way about the way people need and want to be supported during the day. The support plan for one person contained detailed information on how they are supported to manage areas of their life which can cause anxiety and distress. The plan detailed information for staff on how the person must be responded to when they become anxious and strategies which can be used to keep the person safe. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 13 There was information which demonstrated that the plans were supported by a multi disciplinary approach and guidance had been sought from health care professionals in putting together the care plan. The support plan has different sections, there was a section covering health and information for staff on the signs to look for when the individual’s mental health was deteriorating. The care plan had been reviewed with the involvement of the individual and health care professionals involved in the care and support. The support plan is written from the perspective of what the person needs to happen in their life so they can do the things they want to. Individual choices are recorded in the daily record. We spoke to three people who live in the home and they told us that they are able to make decisions about what they do each day and who they see. We looked at the risk assessments for two people. Action had been taken to minimise the identified risks and hazards and through the development of personal goals action was being taken to ensure that where risks were identified it did not affect the life people wanted to lead. Risk assessment were thorough and covered aspects of life both inside the home and in the wider community. The annual quality assurance assessment told us: “Each resident has straight forward attainable goals, which are regularly reviewed and updated. These are set in consultation with the resident and a time limit for meeting them is set.” We looked at the daily records and found that information written each day about activities and people’s routines was accurate and based on fact, however on some occasions staff would comment on an individual’s mood without being clear how they made that conclusion. A health care professional who returned a survey form answered ‘always’ to the question, Does the care service support people to live the life they choose wherever possible? We looked at a sample of minutes from residents’ meetings. We noted that various issues had been discussed including menu choices, trips out, household chores, holidays and activities and people had been able to contribute to decision-making and enabled to voice their opinion. The residents meeting are written up in an accessible format using pictures to illustrate what people have said during the meetings. The service gave an example of how they are supporting people to make choices: “One of our residents wished to go to Church so we made it a priority to help him fulfil these religious needs. Helping him find a church that he liked and Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 14 showing him how to get there independently.” Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the 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 supported to live the life they want to. EVIDENCE: We spoke to three people who live in the service, they told us that they are able to do the things they want to such as going out to the pub, going on holiday and seeing friends. Through goals setting people are encouraged to pursue their interests such as going to specific museums they are interested in and developing activities in the community. Observation of people in their home, discussion with them and inspection of their records indicated that people are offered plentiful opportunities to access their local community and pursue personal interests. We observed that people have individualised programmes which include them attending college, work Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 16 placements, playing sports and attending fitness classes. The Home Manager told us that they are making links with initiatives in the local community to promote people’s integration. The home is using pictures to show what is on the menu for that day and minutes of residents’ meetings indicated that people have a say in menu planning. Meals eaten by people who use the service are recorded and records we looked at were generally in sufficient detail. We observed that one person prefers to wake up later than the others and this is respected with him being enabled to eat breakfast in his own time. Discussion with people who use the service indicated that their rights are respected in the home and they are encouraged to have their say. We observed that people have access to all communal areas of the home and the atmosphere is very much of an ordinary home shared by four people of a similar age. People we met spoke about the contact they have with their families and relatives told us in surveys that they have regular contact with them. The annual quality assurance assessment says: “As stated above helping around the house is a big part of learning to be as independent as possible. We help our residents to do household chores like cleaning taking responsibility for cleaning their bedrooms and helping out with other chores. We also help our residents learn cooking skills providing them with a wide variety of dishes to learn how to cook. Central to this is promoting healthy lifestyle choices with plenty of fresh fruit and vegetables and salads. Every week our residents go shopping and choose what they want to eat that week. In the morning the residents are encouraged to choose what they feel like eating that day and a picture goes on the board illustrating their choice. Our residents are encouraged to choose day activities at the weekend and often go to museums, parks, and the stunning Dorset coastline and country pubs. Also two of our residents attend a regular Friday evening club. One of our residents wanted to go swimming so we organised for him to have swimming lessons supported by a one to one staff. He also enjoys college so we applied for funding for a 1:1 worker as he found it difficult going on his own. Also we also take our residents to the Badminton sessions at the Littledown Sports centre at the weekend, which is an excellent form of exercise, which promotes co-ordination.” They also tell us they are doing: “Also we have continued to help our residents make choices about the activities that they do. One of our residents wished to go swimming so we arranged for him to have lessons supported by a one to one worker. While another resident is encouraged to choose what college courses they want to do. Such as reading and writing, art, music, communication and money skills. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 17 We now have implemented more staffing hours for one to one sessions where individual needs and wishes can be catered for. This will broaden the range and variety of choices we can offer to our residents and also increase their access to evening activities. Also we can allow our residents to choose their appointments and meeting times with health care professionals and social workers.” When we visited the home several of the people living there were doing the weekly food shop. One person told us he liked doing the shopping but was not so keen on putting everything away. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 supported in the way they prefer and their physical and emotional needs are identified and met. The homes policy procedure and training for staff on medication ensures that people protected. EVIDENCE: Care plans are person centred and record how an individual likes to be supported. There was also clear guidance on preferred times of getting up and going to bed. We spoke to people who live in the home and they told us that they are able to wear the clothes they like and are supported to buy new ones. Care plans also provided information and guidance from health care professionals on how people need to be supported with specific health care issues. We found the information in care files to be consistent up to date and accessible. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 19 Two requirements were made in this outcome area at the last key inspection. Care plans had to provide sufficient information with regard to each person’s health care needs, and all staff had to have training on how to complete health care checks such as monitoring someone’s blood sugar levels. It was also recommended that all staff have medication training and this has now taken place. The annual quality assurance assessment says: “A major improvement has been in the recording of appointments. We now have separate sections in the care plan for visits from the social worker, doctors, Psychiatrist, CPN, dentist, optician and Chiropodist appointments It is much clearer now to see what appointments the residents have had over the year and what they need.” We looked at the health records for two people and found that appointments had been clearly logged and the outcome of the appointment also written down. We looked at the health record for one person who has their blood sugar levels monitored and we could not find information in the care plan stating the range which was acceptable, which meant that staff would not be clear about what to do should the check show a higher or lower blood sugar level than was acceptable. A recommendation was made that all records of a seizure should be written by the person who witnessed the seizure. We looked at the seizure monitoring records and cross referenced them with information in the daily records, staff are consistent in the way they are recording seizure information. All the staff who work in the home receive medication training and are using a work book which is signed of by the pharmacist from the pharmacy used by the home. The home uses a monitored dosage system; audits are completed monthly by the manager as well as monthly by the registered provider when regulation 26 visits are completed. We noted that information in care plans about the application of cream was not as clear as it should be in detailing , how , where, when and why the cream is to be applied. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 tell us they are listened to and any concerns they have are acted upon. Staff receive training in safeguarding which ensures they understand how to protect people from harm. EVIDENCE: We noted a flowchart on the kitchen wall depicting the local safeguarding adult’s procedure. Inspection of a sample of care workers’ training records indicated that they had all received training in abuse awareness. There have been no safeguarding referrals or investigations in connection with the home in the past twelve months. On our visit to Apple House the home’s complaints procedure was on display in the hallway. This gives contact numbers for the Responsible Individual, the Registered Manager and the Home Manager so that people who may wish to raise concerns can do so directly with the people in charge of the home. The procedure also gives contact details for the Commission. The Commission has not received any complaints or concerns about the service. The annual quality assurance assessment said: “We have an accessible concerns and complaints procedure where staff and residents are able to air their views. We welcome any feedback from our staff and residents and implement any new ideas or concerns immediately. Any Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 21 concerns remain confidential and treated extremely seriously. Also we have detailed a quality assurance audit of our service. Our responsibility is to protect our residents from all kinds of abuse and is quick to report and record any concerns in this area. We also have a successful financial system in place where residents have access to their own money. They feel confidant that staff protects it.” We spoke to three people who live in the home and they told us they would speak to the manager if they were unhappy or worried about their care and support. This was consistent with the information in three survey forms completed by people who live in the service. A health care professional who responded to the survey form answered ‘always’ to the question, Did the care service respond appropriately if you, a person using the service or another person have raised any concerns? We spoke to the registered provider about safeguarding training, there are some staff that have yet to do the course and until they complete this training they have a work book, which the provider said helps focus them on safeguarding issues and prepares them for the course. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in comfortable, homely surrounding which they chose. The home is clean. EVIDENCE: Apple House is a semi-detached property situated along an ordinary residential street in Bournemouth. The ground floor comprises a lounge, dining area and kitchen with access to the rear garden. There is one bedroom and a separate toilet facility also on the ground floor. The first floor is accessed up a flight of stairs and comprises three further bedrooms, one of which has an en-suite bathroom. There is a shower room and toilet for shared use on the first floor. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 23 We spoke to people who live in the home and they told us that they like the décor in the lounge; they told us it was comfortable, they also told us that they can watch television in their own rooms if they prefer. The annual quality assurance assessment says: “Apple House combines an old fashioned feel of a family house equipped with modern furnishings and fittings. Our residents are immediately made to feel at home with its cosy wooden floors and leather sofas in the lounge. They and their families have commented on how happy they are at Apple House. The kitchen has modern fittings and there is a conservatory providing extra space at the back of the property. All of the residents’ bedrooms are spacious and have bathroom facilities. There are toilets on the ground and the first floor. There is modern shower and bathing facilities. Also it has a spacious garden with a patio where residents can relax or eat when the weather is warm. Apple Houses staff and residents maintain high standards of cleanliness in the home. There is a real sense of team working in the household where everyone works together to maintain a clean environment. There is a cleaning rota for day and night staff to complete. All faults are reported to the House Manager and recorded in the maintenance file. We have a trained handyman who is able to come promptly if needed. One example was when the light fitting in the fridge was broken leaving exposed electrical wires. This was reported immediately as a priority need and was completed in the same day. Apple House is in a prime location near the beautiful beaches of Southbourne. It is ideally situated close to our local bus routes, which go to Bournemouth and Poole and to Christchurch. It is in a peaceful safe area and we have a good relationship with our neighbours. We looked at the maintenance record which detail all the repairs in the home, most of the record was up to date and when repairs were completed they were signed off. We found one entry which had not been signed off. Laundry facilities in the home are in keeping with a small home, there is a utility area leading off from the kitchen. There is liquid soap and paper towels in the bathroom. The home has an infection control policy in place. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to recruitment, staffing and training means that people in the home have a consistent service provided by staff that know them and are recruited and trained to meet their needs. EVIDENCE: The annual quality assurance assessment says: “We have focused on making sure that the staff we have recruited have all the relevant training to work in the service. This has been a transition for the company. Now we have all our own staff we can move forward as an organisation.” Three requirements and three recommendations were made in this outcome area at the last key inspection in July 2008. The service was required to have sufficient permanent staff on duty to support the needs of people living in the service and to provide continuity of service. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 25 This has happened and Apple House Limited now employs their own staff to work in the home. We looked at the recruitment records for three people who work in the service. All three people started working in the home only after the return of a satisfactory Criminal Records bureau check. All three also had satisfactory POVA 1st checks. All three recruitment records had two written references, application forms, equal opportunities, health and criminal record declarations. All three had signed terms and conditions and proof of identity information, such as copies of passport, birth certificate, utility bill or drivers licence. We also noted on one application there was a request for a full employment history from the provider as there were some gaps on the application. Another requirement was in relation to epilepsy training for all staff and this has been put in place and all staff have received this training. At the last inspection of the service we made a requirement for the home to employ enough permanent staff to ensure service users receive continuity of care. The provider has told us in their Annual Quality Assurance Assessment that, for the second half of the year, there has been a ‘regular staff team’ at the home. The annual quality assurance assessment says: “We now have a permanent staff team, which has improved our effectiveness of our service. We regularly have team meetings across the services. They have access to all the core training beginning with the skills for care induction, medication, epilepsy, and diabetes and adult protection. Our staff have regular yearly appraisals, which look at their performance over the year and any issues and training needs that they may have. Since the key inspection last year the registered provider has changed from using an agency for staff and training needs to providing this themselves. There is a training and development action plan for 2009 which details the services development needs and objectives as well as an action plan. The registered provider told us that they used the advice and guidance from an experienced training officer to help them develop their plan. The plan includes ensuring that all new employees complete the Skills for Care inductions standards within 3 months of employment as well as ensuring that all employees work toward the learning disability qualification. The provider is also using the skills for care skills scan to assess the training completed and where the gaps are. We looked at the training records for three people recently employed by the provider. All three people had details and certificates of the training completed either since joining the service or from previous employment. We also saw evidence of forthcoming training already book such as safeguarding. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 26 Nine people currently employed have national vocational qualifications at level three and a further four staff are working towards level three. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 home is run with the people who live there at the centre of the service. EVIDENCE: The annual quality assurance assessment says: “The Home Manager is currently undertaking a NVQ 4 (HC4) and registered managers qualification” The registered provider told us that an application to register the manager was submitted to the commission however it was rejected as one of the documents was out of date. The provider told us they are in the process of re submitting the application. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 28 We looked at the homes fire risk assessment and fire action plan. The fire system was last serviced on 26/06/09 and the last fire drill with evacuation took place on 10/09/09. All fire pointed were last tested on 08/09/09 and there was a certificate in place to confirm this. We looked at the maintenance record which shows when repairs were identified and when they were completed. We noted that one repair of an electrical socket had not been signed of as completed, even although we could se that the socket had been repaired. All portable appliances had been tested in July 2009. The electrical system was checked in January 2009. The homes insurance was up to date and the certificate on display. All staff training in fire safety was up to date. Staff training in moving and handling, first aid, food hygiene and infection control is in place. There are some training gaps however the management team are aware and courses have been booked. All accidents, incidents and injuries are recorded and reported. The home has a quality assurance system in place and when we spoke to people they told us they are asked their opinion about the home. When we were talking to three of the people who live in the home, we noticed that there was a fold away bed in the corner of the lounge, we asked who this was for and everyone said it was for the staff to sleep on. We asked if they thought was OK to leave the bedding in the corner of the lounge, all three people said yes. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 29 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X 2 X Version 5.3 Page 30 Apple House DS0000063160.V377580.R01.S.doc 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. Standard Regulation Requirement Timescale for action 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 YA10 Good Practice Recommendations The registered provider should ensure that when information is recorded in the daily records they are factually accurate and consider what evidence they have to make statements such as ‘seems in a good mood’. The registered provider should ensure that where a health plan states the need to monitor blood sugar levels they state clearly in the plan the acceptable range and what to do if the person is outside this range. The registered provider should ensure that where someone is prescribed a cream the care plan is specific as to how this cream is applied, where on the body, when and why. The registered provider should make sure that the maintenance record is accurate and shows when repairs have been completed. The registered provider should ask people who live in the home, as part of their quality assurance process, what they think about having staff bedding stored in their living and dining room. DS0000063160.V377580.R01.S.doc Version 5.3 Page 31 2 YA19 3 4 5 YA20 YA24 YA39 Apple House 6 YA42 The registered provider should risk assess the landing window which is not restricted and decide a course of action to ensure people are safe. Apple House DS0000063160.V377580.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission Southwest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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