Care Home: Appledore

Similar services:

• Insight - Eastchurch
• Southfields
• Thorndene
• Magenta
• Seabourne House
• 33 St John`s Church Road
• Dovedale Court
• Lyncol House

What the care home does well The home is well run. The registered manager gives support, direction and guidance to the service users and the staff group. She makes sure that the aims and objectives of the home are met and that the service users receive the care they need. Appledore provides the necessary information for prospective service users and their families/representatives to help them make an informed decision as to whether or not the home is a suitable place for them to live in. Information is written in pictures and symbols which makes it more understandable for people who use the service. The service has identified that the people living at the home have never been given a choice about where they live or who they live with. They were all transferred to Appledore when the large local hospital closed. Following consultations and discussion it has been decided that the organisation are going to convert the property into individual supported living flats. This means people will have more independence, autonomy and choice. Each service user has a person centred plan. This gives the staff all the information they require to support and care for the service users in a way that meets all their needs. The plans and allows them to live a fulfilling life while keeping them as safe as possible. People living at the home said that their views are listened to and acted on. They are involved in the day to day running of the home. The goals and aspirations of the people who live at the home have been identified and are being developed. Everyone has an activities programme and the majority of people are doing what they want. Staff surveys told us `Sometimes it is difficult to support people to do the activities they want as there are not enough resources available. Hopefully this will improve and change when people move into supported living`. The service users we spoke to said they enjoy what they do. The people we spoke to told us and indicated that they are happy living at the home. The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with the service users in a respectful and caring way. The service users are encouraged and supported to do as much as possible for themselves and make independent choices and decisions. The routines of the home are flexible in order to support the individual and diverse needs of the people living in the home. One person requested to go to a disco and arrangements were made to make sure there was a staff member available to support them to do this. People are actively encouraged to express their concerns and can be confident that they will be listened to. The home does meet the physical and healthcare needs of the people who live there. There is input from the local specialist teams and people see their doctor when they need to. Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices. What has improved since the last inspection? This is the first inspection at the home since it registered with the commission. What the care home could do better: The registered manager needs to make sure that service users have contracts with the new provider so that their places at the home are protected and they know what they are paying for. There was no evidence available at the home to show that the staff working there had been recruited and appointed using robust policies and procedures. There was no evidence to show that all safety checks and references were sought on staff before they started work at the home. This means that service users may not be fully protected. The registered manager told us this information had not been gathered together following the transfer from the NHS. Some of the staff at the home have not received the training they need to do their jobs effectively and safely. This means that some staff may not have the updated knowledge and skills to support the service users in the way that suits them best. The home needs to develop robust quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the people living at Appledore. Fire safety checks are not being done at the necessary intervals so people may not be living in a safe environment. We did found that there were shortfalls in the monitoring and recording of fire testing and fire safety procedures. The fire assessment was not up to date. This has been reported to the local fire officer, who has now visited the home and has made recommendations. The manager needs to extend audits to make sure all systems used in the home are being checked. This will make sure that all the needs of people are being met and they are as safe as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: Appledore Appledore Mill Lane Eastry Sandwich CT13 0JU     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: Mary Cochrane     Date: 1 4 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 37 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 37 Information about the care home Name of care home: Address: Appledore Appledore Mill Lane Eastry Sandwich CT13 0JU 01304614169 01304614681 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Affinity Trust Name of registered manager (if applicable) Ms Deborah Sarah Venediktova Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accomodated is: Six (6) The registered person may provide the following category/ies of service only: Care home only - PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category/ies: Learning Disability LD Date of last inspection Brief description of the care home Appledore is a bungalow situated in the small village of Eastry. It was originally converted and extended from a bungalow to provide a residential care facility with accommodation for up to six adults with learning disabilities needs. The village is set in a rural area not far from the historical town of Sandwich. There are local shops as well as public houses, a take away and a village hall. The local doctor and pharmacy are easily to get to. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 6 Brief description of the care home The building has a dining area set within a large lounge with furnishings and TV and stereo. There is a recreational/leisure area where Service Users are able to relax or participate in activities. There is also another smaller lounge area with TV and stereo. Each person has their own bedroom Appledore has one utility room, one large bathroom, one shower room and three toilets. There is an office and numerous smaller rooms used for storage. A kitchen is adjacent to the dining area. The home had been under the ownership and management of the National Health Service (NHS). The responsibility for the service has now been transferred to Affinity Trust. The plans for the Appledore in the next year are that the parts of the home will be knocked down and reconfigured as a service suitable for up to six people in singleperson flats. Some communal and recreational facilities will be retained. A detailed breakdown of the service charges is available in the Service User Guide, provided to each service user. These will only change following discussion and consultation with the individual. The homes current fees range from £1900 - £2300 per week. Information about the home, including the inspection report from the Care Quality Commission are available on request from the home. Care Homes for Adults (18-65 years) Page 5 of 37 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 the first inspection to this service. It registered with the Care Quality Commission in April 2009. The visit to the service was an unannounced Key Inspection which took place over one day. The inspection started at 10:00 a.m and finished at 4:00 p.m. The registered manager was available during this time. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. We spoke to 3 service users and 2 staff members during the visit. They told us things about the home and the support and care they receive and give. General observations were made on how people are supported. We had a look around the communal areas and some bedrooms. We looked at the documentation kept by the home. Care Homes for Adults (18-65 years) Page 6 of 37 We saw and discussed service users individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. The AQAA contained the information we needed to assist in making judgements about the service. We sent 6 surveys to people who live at the home, 6 surveys to the staff and 3 to care managers and 3 to visiting professionals. We received 5 surveys back from staff, but none from the other 3 groups. We tried to contact professionals who have contact with the service by phone but we where unable to speak to them. We took into account the things that have happened in the service; these are called notifications and are a legal requirement. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: The home is well run. The registered manager gives support, direction and guidance to the service users and the staff group. She makes sure that the aims and objectives of the home are met and that the service users receive the care they need. Appledore provides the necessary information for prospective service users and their families/representatives to help them make an informed decision as to whether or not the home is a suitable place for them to live in. Information is written in pictures and symbols which makes it more understandable for people who use the service. The service has identified that the people living at the home have never been given a choice about where they live or who they live with. They were all transferred to Appledore when the large local hospital closed. Following consultations and discussion it has been decided that the organisation are going to convert the property into individual supported living flats. This means people will have more independence, autonomy and choice. Each service user has a person centred plan. This gives the staff all the information they require to support and care for the service users in a way that meets all their needs. The plans and allows them to live a fulfilling life while keeping them as safe as possible. People living at the home said that their views are listened to and acted on. They are involved in the day to day running of the home. The goals and aspirations of the people who live at the home have been identified and are being developed. Everyone has an activities programme and the majority of people are doing what they want. Staff surveys told us Sometimes it is difficult to support people to do the activities they want as there are not enough resources available. Hopefully this will improve and change when people move into supported living. The service users we spoke to said they enjoy what they do. The people we spoke to told us and indicated that they are happy living at the home. The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with the service users in a respectful and caring way. The service users are encouraged and supported to do as much as possible for themselves and make independent choices and decisions. The routines of the home are flexible in order to support the individual and diverse needs of the people living in the home. One person requested to go to a disco and arrangements were made to make sure there was a staff member available to support them to do this. People are actively encouraged to express their concerns and can be confident that they will be listened to. The home does meet the physical and healthcare needs of the people who live there. Care Homes for Adults (18-65 years) Page 8 of 37 There is input from the local specialist teams and people see their doctor when they need to. Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices. 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 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 Care Homes for Adults (18-65 years) Page 9 of 37 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 37 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 11 of 37 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. Service users know that the home will be able to meet their assessed need and aspirations. Service users do not know what they are paying for and their places may not be protected. Evidence: The Affinity Trust organisation have developed generic statement of purpose for their services and the registered manager of the home has adapted it so that it reflects the philosophy and ethos of Appledore. Each person at the home has a Service Users Guide which is personalised and individual. The guides are easy to read and contain pictures and symbols. This helps people to understand about the home and what it has to offer for them as an individual. There is information on activities and the support staff need to give. It explains about support plans, activities, staff and the environment. There are a pictures of peoples key workers and the home. It explains how to make a complaint. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: There have been no new admissions to the home for many years. The manager told us that the majority of the people at Appledore were placed there following the closure of the local hospital. They did not have a choice about where they lived or who they lived with. Since the new provider has taken over people are being offered choices about the type of care and accommodation they would like. The long term plan is to provided individual self contained flats for each of the service users. This means people will have more individualised, person centred care and support from a dedicated team of carers. The service users we spoke to were keen to do this. The registered manager and staff team are in the process of re-assessing people to find out exactly what each person needs. This move is going to be done in planned, phased stages. Work on the first flat is due to start shortly. The assessments and plans are being done with the service user at the centre. The people at Appledore have not received contracts from the new company who are providing them with their care. This means they do not know how much they are paying and what services they are paying for. It also means their places at the home are not protected. It is the provider responsibility to make sure everyone has a contract that is signed by the service user or their representative and the registered manager of the home. The manager did tell us that the company have recently appointed a Quality Assurance and Personalisation Manager who will be developing individual contracts for the service users. Care Homes for Adults (18-65 years) Page 13 of 37 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. Service users have individual care and support plans that identify their needs and personal goals. They are supported in taking risks as part of an independent lifestyle. Evidence: Each person living at the home have their own individual support plans which they keep in their rooms. These have been developed with the involvement of each service user. They contain pictures and symbols as well as written text, so they are meaningful to the people who need to use them. These support plans contain information about peoples preferences, likes and dislikes and how they prefer to be supported and what they like to do. There are more extensive and detailed support plans kept in the office. We looked at 2 of these care plans in detail and at specific areas in a third. We saw that the plans are person centred and contained detailed information on how to look after each person individually in the way that they preferred and that suits them best. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Each person has a key worker and they can chose who works with them. The service recognises that people get on a better with some staff than others and they try to accommodates peoples choices as much as possible. The support plans covered all aspects of personal and health, social care, medical and specialised needs. There is direction and guidance in place for behaviour management, interventions, and eating and drinking. Likes and dislikes are included and there is information in place about how people prefer to communicate. We saw that the plans on how to manage behaviours and eating and drinking are very specific and individualised. They focused on keeping people safe and protecting others. We saw that staff followed the directions and guidelines in the plans. The support plans contained the necessary information on the action that is required to make sure that peoples changing needs are met. The plans are reviewed regularly involving the service users and their representatives. They look at what has worked for the person, where progress has been made and what has been achieved. They also look at what is not working and how this can be improved. Since the home were taken over by Affinity Trust in April 2009 they have transferred all support plans and all the other information they have about people onto the new providers preferred system. There is now a great deal of paper work in place for each person so much so that it is difficult to find information easily and quickly. The registered manager told us that now she has got all the information she is going to streamline the plans so that they are easier to use as a daily working tool. Daily records are person centred and contain details to show how the people have made choices and decisions. People have access to and use independent advocacy services to assist and support them in making the decisions. It was possible to cross reference information to show that care plans and risk assessments are being used to provide the necessary care and input on a daily basis. Through observation, talking to service users and staff and from looking at the documentation there was evidence to support that people are involved in making decisions on how they live their daily lifes. Any limitations and restrictions are recorded in the individuals care plan. We saw that staff listened to what the people wanted through various means of communication and acted on this. There was evidence available to show how people choose their meals, how they choose what they want to do and where they want to go. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: Risk assessments are recorded in each support plan. They are used to promote independence and not restrict people. Staff help people to take reasonable risks. Work has been done to ensure that all individual risks have been identified and that procedures are in place to minimise them. Staff did report there is a consistent approach when dealing with behaviours. The staff we spoke to were able to explain about risks and how to minimise them. When new risks are identified they are documented in the individuals care plan. There are procedures in place to make sure that information about people is kept confidential. Peoples plans state that service users need to be asked before anyone looks at information about them. This was evidenced on the day of the visit. Care Homes for Adults (18-65 years) Page 16 of 37 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. Service users are encouraged and supported to take part in appropriate activities. They are part of the local community. Service users are supported to maintain family contact and assisted to exercise choice over their lives. People received a healthy and varied diet. Evidence: We saw that peoples hobbies and things that they like to do are identified in their care plans and from this peoples individual activities programmes are developed Each person has an individual activities plan in place which is tailored to meet individual needs. 3 of these plans were looked at and cross-referenced with the daily Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: records. The records showed that people had participated in the activities that were planned for them. The staff had recorded whether or not the person enjoyed what they were doing or not. We heard staff discussing with service users what they would like to do the following day. We saw that staff actively encourage and support service users to participate in activities. Some service users attend sessions at the local specialist day centre. We saw that one person was gradually being introduced to the local day centre to meet with the occupational therapist. The goal was for the person to start developing cooking skills in preparation for the move to more independent living. This was being planned very gradually and carefully with the home and occupational therapist and the staff told us that progress was being made. We saw that other people attended courses at the local college. Some people do cookery courses, music and drama or gardening. On the day of the visit one person had just joined a weekly walking club which they went to with 2 members of staff. The person had enjoyed this activity and the plan was for it to continue. We saw that staff supported and encouraged service users to do things in the house if they did not go out. Service users told us they enjoyed doing things inside and out-side the home. The service users are also part of the local community and visit the village pubs and other local facilities. People are also supported by staff to attend religious services of their choice. The registered manager told us she is continually looking at ways to improve and develop the activities and leisure pursuits for the service users. The service users are encouraged and supported to maintain contact with their family and friends. People go on home visits and holidays are arranged with service users. One person told us he was going on a fishing holiday in Norfolk. Another person said they had been to the New Forest and had a good time. The service users are involved in the daily routines of the home and are encouraged to take care of their own rooms. Care staff cook the main meals at the home. Service users are not involved preparing meals at the moment as the kitchen is small and does not have the space to do this safely. This will change when everyone has their own individual kitchen. People are supported individually to cook cakes and make Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: snacks. Appledore caters for people who have special diets and we saw evidence of this on the day of the visit. Service users said that they enjoyed their mealtimes and the food is good. They said that they had meals out regularly. People can choose when to be in the privacy of their own rooms or in the communal areas. Members of staff were observed demonstrating good body language and communication skills when interacting with the service users. They were seen to talk and interact in a positive way and involved and included service users in conversations. Care Homes for Adults (18-65 years) Page 19 of 37 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 know that they will have the support they need to stay healthy. People have the support they need regarding their personal care. Medication practises are safe protecting the people who live in the home. Evidence: During the visit we saw and were able to evidence that personal care is delivered in a way that is flexible, reliable and person centred. We saw that life skills and dignity are promoted. The staff were seen to respect the privacy and dignity of the service users allowing them control over their own life. Each person living at the home has a key worker. This promotes sensitive and individual support to the service users. We saw that individual plans clearly record how the service users like to have their personal needs met. They focus on what people can do for themselves and detail exactly how staff will give the support needed while allowing the service users to be as independent as possible. Staff have got to know each person well and have found out how they like to be supported with their personal care. Routines have been Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: established and guidelines have been written for the staff so that everyone is doing the same thing. There is a flexible approach to daily living activities e.g. getting up, going out, bed, bath and mealtimes. People choose their own clothes and are supported to shop. Staff were seen to approach service users in a caring and supportive manner. Service users health is closely monitored and if any problems arise they are dealt with promptly and appropriately. The service makes sure that people have access to all the healthcare facilities. We saw that routine checks and monitoring are carried out at the necessary intervals. People are promptly referred to specialists when the need arises. We saw that people had contact with the speech therapist, psychologist, the local learning disability team. Some people have support from specialist hospital units. Some of the people have complex health needs. The service was able to evidence that these are well managed. There is information in the plans, which highlights early warning signs of identified health needs, this means staff can take immediate and appropriate action. A member of staff accompany people when they are attending appointments. A report is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments. There was a lot evidence to show that staff are pro active in seeking specialist support when it is needed and do everything possible to make sure the complex needs of the people are met. Any changes in health care is updated in the persons care plan as soon as possible. This makes sure all health needs are identified, met, monitored and reviewed at the required intervals. Medication is stored safely and at the correct temperature. The home uses a predispensed system for administering medicines. This means that the medication is administered to people more safely as it has been pre-packed by the pharmacist in blister packs. Some medication is stored in its original packing. We saw that this medication was not stored in a personalised way but kept all together. The manager told us she would make sure peoples medication is individualised. The future plans for the service are for each person to have their medication in their own flats. All prescriptions sheets had been signed to indicate that service users have received their medication on time and safely. The staff who administer medication have received the necessary training and their competencies are checked. We looked at the Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: prescription sheets. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. The people living at the home receive their medication as prescribed by their doctors. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. There are clear guidelines for giving medication and medication is given to people in a way that is individualised and best meets their needs. This makes sure that the medication is administered consistently and the effects monitored. The registered manager has had discussions and advise form the pharmacist on how to best to make sure people have their medication when they leave the home for activities or days out. She is continuing to explore the safest options for this. We saw that the service has has clear procedures in place for caring for individuals who have long term illnesses who may require terminal care. They also have plans in place that contain information about what people want to happen when they die. Best interests meetings have been held well in advance with external professionals so that care can be pro-active and well planned. This means that people will receive the specialist care that they need when they need it and their wishes choices will be respected and met. Care Homes for Adults (18-65 years) Page 22 of 37 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 home has a satisfactory complaints system and service users are protected from harm and abuse Evidence: The home encourages and support people to express their views and concerns. There have been no complaints made to the home since it was registered with the commission in April 2009. Everyone has a copy of the complaints procedure which is written in a picture and symbol format. This means that it is more understandable for the people who use the service. If people have a concern or complaint they are able to effectively let the staff know. One service user told us if they are worried about anything they would speak to the manager. There are also regular service users meetings where people can express their concerns and how they want things to be done in the home. The service know when to report any incidences to the local social services safeguarding vulnerable adults team. The AQAA told that they have made 5 referrals to this team but no alert has been raised as it was decided that the home have competently managed the situations according to their policies and procedures and service users are protected. The majority of staff have received training in safe guarding vulnerable adults and for Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: those who havent (who are mainly the new staff) training is being booked. People can access advocacy services if they need to. We were told that all the service users have contact with an advocate. This means that people get independent support and advice in areas that affect decisions around how they prefer to live their lifes. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. At the time of the visit the home did not have access to the original checks as they are kept at the companys head office but they did have the necessary criminal bureau records check reference numbers. The registered manager told us that she is will be requesting the original documents from head office. (This will be discussed later in the staffing section of the report). The service has records to demonstrate that the service users finances are managed appropriately and safe guarded. The registered manager is able to audit and trail monies. The home is developing systems of supporting people to have more independence to look after their personal monies. This system further protect them from the risk of financial abuse. Care Homes for Adults (18-65 years) Page 24 of 37 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. The majority of the home provides an environment that is appropriate to the needs of the people who live there. Bathroom facilities do not met peoples needs. Planned improvements to the premises will enhance peoples lives and make the home a more attractive place to live. Evidence: The registered manager told us that the long term plan for the service is to restructure and redevelop the premises to provide individual flats for the six people who presently live at the home. This has been decided following discussion with service users, relatives/ representatives, care managers advocates, the care service provider and a housing association. The work on the first flat is due to start shortly. The manager told us this will not directly impact on the service users and they will remain in the home while this first stage of the plan is completed. The company are in the process of developing contingency transition plans for when people will have to leave the premises so work can continue. The registered manager is aware that the commission needs to be kept up to date on what is happening at the home. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: The people we spoke to told us that they are looking forward to having their own place. Because of the future plans, maintenance is done on a when needed basis. There is a maintenance person employed by the company who visits the home when needed. We looked around different areas of the home. We looked at all the communal areas and some of the service users bedrooms. There is a main lounge/dining comfortable chairs and TV and stereo. There is also another smaller lounge area with TV, stereo, comfortable chairs. This lounge also has games, books and other activity resources. We saw people relaxed and enjoying the facilities. The gardens around the home are well maintained. They provide space for people to sit and relax or do out door activities. We did find that the door to the garden is kept locked at all times. This means that people cannot access the garden without asking staff to let them out. The registered manager told us the reason for this and it is documented as a restriction in a care plan. We were told that the service are looking at ways to reduce this restriction and that the problem will be solve when individual accommodation is built. We did see that staff are available to make sure people can go into the garden when they want to. We asked service users if we could look at their bedrooms. Two people showed us their rooms. They said they liked their rooms and one person said they will glad when they have more space to put things. The rooms are individual and reflect the personality and interests of the person. Some service users have key to their bedroom which enables them to lock their own bedroom door when they are not in their room. The service has accessed the equipment they need to meet the needs of the people who use the service. There are wheelchairs available for people who cannot walk long distances but like to go out and about. The home has 1 bathroom 1 shower room and 3 toilets. The bathroom/shower areas are bare but functional. We found that the bathroom did not have any toilet paper and the hand-dryer and taps on the sink were not working. This is hygiene and infection control issue as people have not the facilities to keep clean and reduce the risk of cross infection. The registered manager told us she would address the issue immediately. She did tell us that the home are in the process of purchasing more robust equipment for the bathroom as the toilet roll holders recently been had been pulled off the wall. She could offer no explanation as to why the hand-dryer and sink taps were not working but said that she would get the maintenance man to look at Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: them. Since the visit to the home the manager informed us these issues have now been addressed. There is a laundry room which contains all the necessary equipment and some service users are supported and encouraged to do their own washing. Care staff do the cleaning at the home and service users are supported to help with their own rooms. On the day of the visit the home was clean and fresh. Care Homes for Adults (18-65 years) Page 27 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to support the people living at the home. Staff have not had the training to make sure they have the competencies and skills to support people. Present recruitment practises do not protect the people living at the home. Evidence: We sent surveys to staff who work at the home they told us The staff work well together as a team. There is a good communication and good relationships have developed with the service users. We could do with more staff at times to make sure service users can do what they want. We think this will improve when the service users have their own flats and a dedicated team of staff working with them individually. At the time of the visit the home employed 18 members of staff. They are in the process of employing an extra person to increase the staffing levels at night so there will be 1 sleep-in and 1 wake night staff. This will mean that service user will have the support that they need at all times. We saw that the staff support and communicate with service users in a respectful Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: manner and are accessible and approachable. It was evidenced that the staff on duty put the needs of the service users first. People responded positively and openly to staff. Some of the staff have worked at the home for a reasonable length of time and have a good knowledge and understanding of the service users. The staff were professional and responsive on the day of our visit. They explained about risks and behaviours of the service users and explained ways that the risks could be reduced. This means that people entering the home have minimum impact on the daily lives of the people who live at Appledore. There are gaps in mandatory training. The manager is aware of this and told us that the the company are in the process of identifying the shortfalls and will then access training for staff over the next few months. The staff are also going to receive more specialist training to make sure that they have the skills, knowledge and capabilities to care effectively, positively and safely for the people at the home. The manager is developing a training matrix so gaps can be identified quickly. This was not completed at the time of the visit. This means that the registered manager cannot see at a glance which staff need training and what areas the shortfalls lie. We were told that all new members of staff receive an induction into the home and have an induction training programme in place. This programme is linked to skills for care. We saw evidence of this during the inspection. We were told that all new staff receive an initial 4 week induction programme. During this time they spend 3 days practical training at the home and 2 days theory in a classroom situation. New members of staff told us that the induction training was good and thorough. They said that it gave them the initial confidence and skills to work in the environment. We were told during this time new staff shadow an experienced staff member. We saw evidence that staff competencies are checked to make staff do their jobs effectively and in the best interests of the people who live at the home. People are observed undertaking various tasks and a record is kept of these observations. Any shortfalls are addressed with the staff member so practises are improved. We were told that staff have regular supervision and we saw evidence of this. Staff told us that they feel supported. Staff have regular meetings to discuss any issues that have been identified. They look at what is working well at the home and what needs to be improved The home has an NVQ programme for care staff and the service told us that 8 people out of 18 have achieved this. They have almost reached the target of more than 50 Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: of care staff with NVQ level 2 and will continue to work towards more staff achieving NVQ qualifications. Affinity Trust does have recruitment policies and procedures. We looked at three of the staff files these included 2 of the most recently employed staff. We found that the staff files kept at the home do not contain the information needed to make sure all the necessary checks and information has been gathered so a decision can be made to whether the staff are suitable to work with vulnerable people. The provider of the service does not have an agreement with the commission for all staff files to be kept centrally. The manager told us because the service had transferred from the NHS to Affinity Trust six months ago all the existing staff files are head office. However we also found that files of new members of staff are not kept at the home. The registered manager is aware of the shortfall and told us that she would address this. The registered manager is involved with interviewing new staff but not with the paper work. We have been told that Affinity Trust have applied for and have now received new Criminal Records Bureau (CRB)checks for all staff working at the home. This means the home are taking precautions to protect people. The home does keep a record of CRB reference numbers. Care Homes for Adults (18-65 years) Page 30 of 37 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. The registered manager is qualified and has relevant experience to run the home. She is aware of the areas that need improvement and has plans to do this. People can be sure that their health and welfare is promoted and protected. But they cannot be sure their safety is fully protected. Evidence: The home has a registered manager, Mrs. Deborah Vendediktova. She registered with the commission at the beginning of April 2009 but was previously managing the home when it run by the NHS. She has over 14 years experience as a home manager. The interview she had with the commission showed she has the skills and experience to run the home. The registered manager has a clear understanding of the key principles and focus of the service. She is aware of the shortfalls within the home and has the vision and plans on how these will be addressed. She is working continuously to improve the service and provide and the quality of life of the service users. She understands the Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: importance of person centred care and actively promotes and leads the staff team. The registered manager and senior staff have received Mental Capacity Act training and Deprivation of Liberties training. There will now be a roll-out programme to the rest of the staff team. We observed at the visit that the service users have a positive and relaxed relationship with the manager. Staff told us that the manager is approachable and understanding. They said that they could speak to her about any concerns they might have. Although we have identified shortfalls that need to be addressed by the registered manager, we are confident that the appropriate action will be taken by the registered manager and the organisation to resolve these issues. The manager has already taken steps to do this. We received an AQAA from the home when we asked for it. However some of was not sufficient to assist us with parts of the inspection process. It needed to contain more detailed information and examples about how the home and how people are supported. It needs to give more information on what they do well and how they plan to improve in the future. The AQAA did tell us that all the relevant checks and inspection of equipment, gas and electric systems have been done. Because the service is new, quality assurance questionnaires have not yet been sent to people. We were told that the company has recently appointed a Quality Assurance and Personalisation Manager. We were told that this person will be responsible for developing and sending quality assurance surveys to service users, staff, relatives and other people who have an interest in the service. This information will then be collated to identify the strengths and weakness of the home. The company has already identified shortfalls in the way service users receive the care that they need. They are taking the steps to provide individual flats for people. Support and care will then be holistic and individual. People will be able to develop the skills and live a more independent life style. The home is visited monthly by the area manager to make sure the home is providing the required standard of support and safety for the people who live at Appledore. Any shortfalls are then actioned by the manager. Some of the shortfalls identified at this inspection had not been identified at the monthly visits. The registered manager is doing some regular audits on the systems used within the home to make sure peoples health and safety is being protected. But some areas have been overlooked. Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: We did however find shortfalls around fire precautions, safety checks and procedures. This has left people at risk. The registered manager has not made sure that the necessary tests of fire equipment have been done. We found that fire alarms had not been tested at the necessary intervals. Emergency lightening, fire fighting equipment and fire exits had not been checked to make sure they were safe and working. We also found that there was no evidence that the home had done a fire drill. The fire risk assessment had not been updated for 3 years. This shortfall has been reported to the local fire office who have subsequently visited the home. They have advised have advised the occupiers that they need to obtain servicing contracts from competent persons for the fire alarm systems, emergency lighting and fire extinguishers, which appear to have been neglected when the ownership changed from NHS to Affinity Trust. A fire risk assessment needs to be completed by the occupiers, with supporting policies in place. The fire officer is going to return to the service to make sure the work has been done. A requirement will be made in the report . Care Homes for Adults (18-65 years) Page 33 of 37 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 34 of 37 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 1 34 19 There needs to evidence in place to show that recruitment policies and procedures are adhered to. There needs to evidence that safety checks have been completed. To make sure people at the home are protected by the companies recruitment procedures. 30/11/2009 2 35 18 All staff must receive the 31/12/2009 mandatory and specialist training they require to meet the assessed needs of the people living in the home. the home. To make sure staff have the skills, knowledge and competences to look after people in a way that suits them best and keeps them safe. 3 42 23 All fire safety checks and drills need to be done at the 31/10/2009 Care Homes for Adults (18-65 years) Page 35 of 37 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 required intervals. The fire assessment needs to be up to date. To make sure the people living at the home are as safe as possible. To make sure staff have the training and know what they have to do in the event of a fire. 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 36 of 37 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. Care Homes for Adults (18-65 years) Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!