Care Home: Apsley House

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What the care home does well The staff providing made by "the staff staff". team were well trained, committed, enthusiastic and motivated to a high level of care to the people whom they supported. Comments service users included, "I like all the staff", "they`re great", "nice", listen to me", "my key worker is good" and, "I get on well with all theBefore new service users came to live at Apsley House, the managers made sure they had all the right details about them, so that they were clear that the home was the right place for them to live and that their needs would be met.Service users` care plans were detailed and set out the goals they were hoping to achieve. The staff then supported them to achieve their set goals. The service users were supported to make decisions about their daily routines and lifestyles and encouraged to be as independent as possible. In order to try and reduce health and safety risks, assessments were written which the staff took notice of. Service users were going out into the local area and taking part in activities, which they enjoyed, sometimes as a group or on an individual basis. Evening and weekend activities were also arranged so that the service users did not get bored and those spoken to felt their social lives were good. The service users were supported and encouraged to keep in contact with their relatives and to make new friends whom they could invite to the house. Service users knew how to make a complaint and felt any problems they had were always listened to. The staff were also trained in what to do if they felt service users were at risk of harm and the home worked well with other social and health care professionals. There had been no changes in the staff team since the last inspection and this meant that trusting relationships had been built up between the service users and staff. The staff had all achieved NVQ training qualifications, which showed their commitment to doing their jobs well. There were good systems in place for the manager/owners to check how well they were meeting the needs of the people living at the home. This is called a quality monitoring system. The management team worked well together to deliver a safe, person centred service for the people living at Apsley House. What has improved since the last inspection? The manager/owners` hours were now being recorded on the staff rota, so that it was clear what hours they were spending at the home. We were assured that when anyone new starts work, the manager/owners apply for a new Criminal Record Bureau check to make sure the person is suitable to work with vulnerable people. As no new staff had started work since the last key inspection, this could not be checked out. In preparation for the annual report, questionnaires were now being sent out to a wider range of people so they could say what they felt the home did well or what it could improve upon. What the care home could do better: No requirements were made at this inspection as it was felt the home was being well run with good outcomes for the people living there. CARE HOME ADULTS 18-65 Apsley House 103 Queens Park Road Heywood Rochdale OL10 4JR Lead Inspector Jenny Andrew Unannounced Inspection 20th November 2007 08:30 Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apsley House Address 103 Queens Park Road Heywood Rochdale OL10 4JR 01706 360309 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Linda Bell Mrs Janet Kinsella Mrs Janet Kinsella Mrs Linda Bell Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 4 service users, to include; up to 4 service users in the category of LD (Learning Disability) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 12th July 2006 Date of last inspection Brief Description of the Service: Apsley House is a privately owned, small care home accommodating four younger adults with learning disabilities who need support to lead independent lives. The home is a spacious, end of terraced house, near to the centre of Heywood with good access to a range of community facilities and public transport links. A park is situated close by. All four bedrooms have en-suite facilities and are situated on the first and second floor levels of the home. As there is no lift, the home is unsuitable for anyone with mobility difficulties. This is published in the statement of purpose. Car parking space is available at the side of the house and there is a small garden area to the rear. The weekly fees are dependent upon the assessed needs of the individual. No additional extra charges are made. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the Commission for Social Care Inspection’s (CSCI) inspection report is held in the office. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted eight hours. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, looked at the way medication was given out and stored and watched how the staff supported the people in their care. The files of three members of staff were also checked to make sure the manager was doing all the right checks before she let the staff start work. In order to obtain as much information as possible about how well the home looks after the service users, the two owner/managers, four service users and three support staff were spoken to. Before the inspection, comment cards were sent out to service users, staff and relatives/advocates asking what they thought about the service. Four service user, four staff and three relative/ advocate questionnaires were returned and this information has also been used in the report. Before the inspection, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what the management of the home feel they do well, and what they need to do better. This helps us to determine if the management see the service they provide the same way that we see the service. Upon its return, it was evident the manager had spent time and effort in completing it and had highlighted good practices in respect of equality and diversity. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. What the service does well: The staff providing made by “the staff staff”. team were well trained, committed, enthusiastic and motivated to a high level of care to the people whom they supported. Comments service users included, “I like all the staff”, “they’re great”, “nice”, listen to me”, “my key worker is good” and, “I get on well with all the Before new service users came to live at Apsley House, the managers made sure they had all the right details about them, so that they were clear that the home was the right place for them to live and that their needs would be met. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 6 Service users’ care plans were detailed and set out the goals they were hoping to achieve. The staff then supported them to achieve their set goals. The service users were supported to make decisions about their daily routines and lifestyles and encouraged to be as independent as possible. In order to try and reduce health and safety risks, assessments were written which the staff took notice of. Service users were going out into the local area and taking part in activities, which they enjoyed, sometimes as a group or on an individual basis. Evening and weekend activities were also arranged so that the service users did not get bored and those spoken to felt their social lives were good. The service users were supported and encouraged to keep in contact with their relatives and to make new friends whom they could invite to the house. Service users knew how to make a complaint and felt any problems they had were always listened to. The staff were also trained in what to do if they felt service users were at risk of harm and the home worked well with other social and health care professionals. There had been no changes in the staff team since the last inspection and this meant that trusting relationships had been built up between the service users and staff. The staff had all achieved NVQ training qualifications, which showed their commitment to doing their jobs well. There were good systems in place for the manager/owners to check how well they were meeting the needs of the people living at the home. This is called a quality monitoring system. The management team worked well together to deliver a safe, person centred service for the people living at Apsley House. What has improved since the last inspection? The manager/owners’ hours were now being recorded on the staff rota, so that it was clear what hours they were spending at the home. We were assured that when anyone new starts work, the manager/owners apply for a new Criminal Record Bureau check to make sure the person is suitable to work with vulnerable people. As no new staff had started work since the last key inspection, this could not be checked out. In preparation for the annual report, questionnaires were now being sent out to a wider range of people so they could say what they felt the home did well or what it could improve upon. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users were assessed in full, before coming into the home, thus ensuring staff were able to meet their identified needs. EVIDENCE: The four resident comment cards that were returned said they had all been asked if they wanted to move into the home and that they had been given sufficient information before they had moved in. Comments made included, “I knew the people who already lived here”, “I had a letter” and “I got a file”. The manager said they admitted people via the Social Services Department and only after having received a full assessment of the person’s needs. Since the last inspection, no new service users had been admitted. Care management assessments were held on each person’s care plan file and these were seen to include a lot of information and detail. Once the service user was admitted, a full in-house assessment took place over a period of approximately four weeks, which included risk assessments. These assessments were seen on the files that were checked. All this information was then used when drawing up the person’s care plan. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 10 When service users had any particular needs or medical conditions that the staff were unfamiliar with, then either in-house or external training was arranged. Staff files evidenced the following training: epilepsy, sexuality, diabetes and challenging behaviour. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Care plans and risk assessments were detailed and contained the right kind of information so that the staff team would be able to care and support the people in their care to meet their identified goals. EVIDENCE: The service catered for four people with varying needs and abilities. The care plan files and risk assessments for all four people were looked at. Each person had two files in place, one with all care plan and risk assessment documents and the other with health care information and letters and other important information. This file was indexed so that documents could be easily located. The care plans were detailed and contained the right kind of information so that the staff team would be able to care and support the service users to meet their identified goals. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 12 The care planning process was very person centred and the pen pictures at the beginning of each care plan file immediately identified an individual’s likes/dislikes, hobbies/interests and people who were important in their lives. Equality and diversity issues had been addressed, including religious needs. Service users who could sign their plans and risk assessments had done so and, from discussions, it was clear that the service users were fully involved in the care planning process. “Listen to Me” care plan booklets were on the files, which could be more easily understood by the service users and one of the support workers said that each person held a copy in their bedrooms. Observation of records and care plans indicated the encouraged and supported to be as independent capabilities. Examples of this were noted in daily “had bath unsupported”, “went to Morrison’s for a laundry down”, “assisted in cooking tea”. service users were being as possible within their recordings, for example, personal shop”, “brought It was evident that one of the key principles of the home was that people using the service were in control of their lives and fully involved in decisions about their day-to-day support and routines. Progress towards identified goals was recorded on both a daily and monthly basis and all the staff spoken with were familiar with each person’s support needs. Two of the service users were able to say what some of the goals were they were working towards. In order to try and keep the service users motivated towards achieving their goals, a “service user of the week” monetary reward was given. So that more immediate rewards could be enjoyed, a new initiative had been introduced whereby a “lucky dip” present was given. One of the returned staff comment cards said, “Care plans are reviewed on a daily basis with staff working to support people the way they want to be supported and to help them achieve their goals”. Another comment card recorded, “Communication at Apsley and throughout the company is very good”. Annual care management reviews took place, which included the service user, their key worker and any other person they wanted to invite. The review meeting minutes were seen on each of the care plan files. Where more regular reviews or advice was needed, the management team liaised with the Social Services Department or specific health care specialist. The three returned comment cards from relatives/advocates indicated general satisfaction in respect of the home meeting the needs of the people living there and all three confirmed that the staff were giving the right support to the person they visited. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 13 A key worker/co-key worker system was in place and it was working well. Three of the four service users spoken to knew who their key worker was and said they liked this person and all three support workers demonstrated their knowledge of the people they supported. There had been no staff turnover over since the last key inspection in July 2006, enabling trusting positive working relationships to be formed between service users and support workers. If service users wanted to choose another worker to do activities with, who may share their interests or be nearer their age, then this was accommodated. One service user said she had chosen the support worker she wanted to go to see a pop concert with and another service user said she had chosen the staff member she had wanted to go on holiday with last year. From speaking to staff, it was evident they were enthusiastic, committed and motivated about their support worker/key worker role. Regular one to one time was spent with each person and this was seen during the visit. One person was supported to her weight-watcher class and another person supported to go horse riding. The high level of staff commitment towards motivating service users, identified at previous inspections, has continued, even though there have recent set backs in respect of one of the service users. The service users spoken to felt they were able to make many daily decisions about their lifestyles and routines. One service user said she used public transport and visited her friends whenever she wanted. Another person said she enjoyed having a friend to tea and sometimes to stay over. Those service users who were able to manage their own money were encouraged to do so with the necessary staff support. The manager had accessed advocate input when it was identified this was a need and service users were supported to have family contact. Regular service user meetings took place so that they could put their points of view forward in respect of daily routines and other issues that they wanted to discuss. Returned comment cards about making day to day decisions recorded the following: “I stay at my friend’s house”, “Staff try and get me to do different things”, “I go out when I want on my own” and, “My friend sleeps at weekends”. Staff also spent time during the evening, sitting with the service users to complete a daily planner for the next day. This was so people could say if there was anything special they wanted to do and also to give more structure to their day. The service very much focused on the “can do” attitude and risk assessments were seen which promoted people to follow their chosen lifestyles. The assessments highlighted the risk and, if felt to be manageable, identified the measures in place to lower them. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 14 Assessments were in place in respect of many different areas and included, spending time unsupported in the house, cooking, riding a bike, vulnerability, using public transport and self-medication. Assessments were also done in respect of behaviour management and specialist advice and support was sought during this process. Challenging behaviour was monitored and recorded in order that staff could establish whether there were any triggers or particular patterns leading up to behavioural issues. Staff meetings were used to talk about any problems experienced with individual service users, so that ideas of what worked and did not work could be discussed as a team. The manager at one of the owners’ other homes was experienced in behaviour management and her knowledge and expertise was used when problems were experienced. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 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): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The range of opportunities available for service users to pursue educational, community and leisure activities reflected their diversity, social, intellectual and physical capabilities, thus increasing their independence and self-esteem. EVIDENCE: The home’s philosophy was based around the principles that service users’ rights to live ordinary and meaningful lives should be promoted. From checking support plans and reading daily recordings and review meeting minutes, it was clear the staff team had a strong commitment to encouraging and enabling service users to develop their individual skills, both in-house and within the local community. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 16 Whilst in the past, some service users had been supported to do voluntary or part-time work or attend college courses, at the time of this visit only one person was doing voluntary work in a charity shop. This was not to say that service users had not been given every encouragement and opportunity to do other meaningful daytime educational or work opportunities. It was the service users who had made the ultimate decisions that the courses or jobs they had done were not working out. An example was given where one service user had recently enrolled on a college course and the home owners had gone to considerable expense to ensure sure she had the right clothing and equipment needed. After a short period of time, she had indicated she was unhappy on the course and, as a result, she was no longer attending the course. Staff were now looking for other educational or day time pursuits that may be more suitable for her. A support worker said she enjoyed assisting one of the service users to improve their literacy skills and that she was learning to write. The daily programmes also indicated that life skill training was encouraged during the evenings when the service users were not going out. This included, cooking, baking, washing up and doing their own laundry. Daily plans were discussed each evening so that the service users could put forward any ideas of what they might like to do the following day. The staff then encouraged them to do their planned activities. The staff were also working hard as a team to try and motivate one of the other service users to do more during the day. Whilst they were finding this difficult, they were continually looking at alternative things that this person might be interested in taking part in. A “pamper and meditation” night on a Saturday had been really well received by the service users, which recently had been attended by all four people. From discussion with service users and staff, it was evident the service users were encouraged to utilise a wide range of community activities and to pursue individual hobbies and interests. The rota accommodated both individual and group activities, which meant that service users could choose whether or not to take part. Community activities currently being enjoyed included: visits to the cinema, the market, pubs, cafes, McDonalds, supermarkets, weight watcher class, walking in the park, swimming, water aerobics and horse riding. One person was considering joining a gym/sauna. Two of the service users had attended a “prom” evening at Rochdale Town Hall and it was clear from the photographs that they had thoroughly enjoyed getting dressed up for the occasion. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 17 Two service users were keen football supporters of Manchester City and Manchester United. The staff had managed to get one person tickets to go to watch a match and another staff had got an invite to look around the Manchester United stadium. They were really looking forward to these experiences. One service user was really excited about going to a McFly pop concert and had chosen one of the younger support workers to go with her. She had made McFly posters for her bedroom and had already bought a hat to wear for the concert. One of the support staff was trying to motivate service users to take up new interests, such as knitting and sewing, and had planned to offer support in making aprons for when they did the Christmas cooking. She was bringing in different materials so they could choose their own fabric and colours. Special occasions were celebrated and a Halloween party had been held. The photographs that were seen, clearly showed how much the service users had enjoyed it. The use of public transport was encouraged, subject to a risk assessment having been done and three of the support staff had cars that were insured for business use. One service user described the holiday she had been on this year with two of the other service users and a mutual friend. This had been funded by the owners and had been a themed holiday in Yorkshire. One of the service users, who had chosen not to go with the group, had been to Ireland with the support worker of her choice. Next year, the service users had requested a caravan holiday as they had previously enjoyed this kind of holiday. Two lounges and a dining kitchen were provided on the ground floor. Smoking for service users was allowed in one the lounges. The window in this room could be opened and the door was kept shut. However, when entering the room it smelt strongly of smoke. As the domestic was a non-smoker and responsible for cleaning the room, in order to ensure her health needs were met, the manager had bought a pack of face masks so that she would not be inhaling smoke. Service users’ cultural/religious needs were identified as part of the preadmission assessment process and recorded on the support plan. The needs of the current service users were being met. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 18 Feedback from staff and service users, indicated staff supported service users to maintain family links and the daily records also confirmed this. Three relative/advocate comment cards were returned and all felt the manager and/ or staff kept them informed of important matters affecting the person they visited. All the service users were encouraged and supported to keep in regular contact with their friends and family. A new initiative had recently been introduced whereby relatives were invited to attend six monthly general meetings. It was felt this format would assist people to make informal networks so they could discuss any problems or issues with each other as well as with the staff. Service users had already made plans for Christmas, which involved either going out or having people for meals. A joint Christmas party was in the process of being arranged for service users living in all three homes and their relatives/advocates/friends. As the service users visited the people living in the owners’ other two homes on a regular basis, they knew everyone well and felt this was a good idea. Service users spoke very positively about friendships they had formed outside of the home and said their friends were always made welcome when visiting. One service user said she was getting a bed that was a double bed at the bottom but opened out to a single bed at the top so she could have a friend to stay over more often. Visits to the Gateway Club were enjoyed, as this was also a place where they could meet up with their friends. One service user felt she could confide in her key worker if she had any relationship problems. From speaking to the service users and interviewing staff, it was apparent that furthering service users’ independence skills was a high team priority and the goals setting process on care plans evidenced this. On the day of the visit, one of the service users was making spaghetti bolognese for tea, with very little staff input. Another service user was changing her bed and cleaning her room and two of the service users were supported to go out clothes shopping. Notes on daily records recorded “prompted X to wash hair and have a shower”, “reminded Y to put her clothes out” and “Z assisted to make the tea with some support”. One service user walked to the newsagents every morning to pick up a newspaper. This was part of her healthy living plan. Service users were given keys to their bedrooms and were able to use their rooms whenever they wanted. All the service users were encouraged to make drinks and snacks for themselves. Rules and regulations were kept to a minimum, ensuring that service users had control over their lifestyles. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 19 Both staff and service users were responsible for the cooking of the evening meals. The planning of weekly meals was usually done on a Tuesday evening when everyone would sit around the kitchen table to decide what they would like to see included on the menu. Staff encouraged them to try and choose healthy options and would give advice and assistance in this. Special dietary needs were taken into account. Food shopping was usually done on a Wednesday at a local supermarket. The menus seen reflected healthy eating. Desserts were also healthy, as staff were trying to make sure that service users did not increase their weight. If problems were experienced in respect of diet, individual diet sheets were used for recording purposes. One service user had been prescribed supplement drinks and she came to the office to get one during the visit. One of the service users was attending weekly Weight Watcher classes and had been doing so for about nine months. The staff had given her encouragement and support during this time and she had done brilliantly, losing a massive 38lbs. This person said she could now go out walking without becoming breathless and was really pleased about how much better she looked. She also said, “The staff have really helped me with healthy eating”. In order to encourage people to try different cultural food, special themed evenings were planned and an Indian meal was being arranged for the Saturday after the visit. On a Sunday, service users enjoyed a full cooked English breakfast. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care that service users received was offered in such a way as to promote and protect their privacy, dignity and diversity. EVIDENCE: Support plans recorded what help service users needed, along with their preferred routines. Three of the four service users only needed reminders or prompts in respect of their personal care needs. It was clear that the staff on duty knew each individual’s chosen routine and had consistent effective ways of working with them. Privacy and dignity were respected and this was seen during the visit. Staff knocked on bedroom doors and waited to be asked to come in, gentle reminders about personal care tasks were given and they spoke to all the service users in a respectful and professional way. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 21 One returned questionnaire had commented that they considered the staff sometimes developed too close personal relationships with the service users and, in some instances, felt they were “mothering” them. This was discussed during the visit and it was felt that with such a small team of workers and service users this was difficult to prevent. However, all the staff spoken to said they were aware of the need to maintain professional relationships and not to get too emotionally involved. The small team of support workers were all women, which met the needs of the four women service users. The age mix of the staff varied which enabled the service users to be supported by people near their own age to places such as pop concerts or when shopping for clothes. One service user said she enjoyed going out buying clothes with her key worker and that she valued her opinion. The support staff encouraged each person to choose their own clothes, hairstyles and make-up but guided them in this process. The care plan files showed that service users were supported to attend healthcare check-ups and attend appointments with GP’s, nurses, continence advisor, psychiatrists and specialist clinics. Any visits were recorded on the care plan, together with the outcome of the visits. During the visit, a private podiatrist was visiting, as it was felt that the service provided by the Health Authority was insufficient to meet their needs. Any specific medical problems were recorded on the care plans and staff were responsible for making sure they followed the plan. Staff encouraged service users to attend Well Women check-ups and also to have other health care checks if it was felt necessary. As highlighted above, one of the service users had been supported to attend a Weight Watcher class and had made fantastic progress having lost a total of 38lbs. When any problems were identified, either emotional or physical, the management team was knowledgeable about whom to seek help and advice from. The organisation had excellent links with a community behaviour management worker who was able to give advice and training to the staff when required. The home was unsuitable for people with a physical disability as the accommodation was on three levels and there was no passenger lift. This was, however, identified in the Statement of Purpose and Service User Guide. The present service users were all able to easily access the facilities and did not need any special aids or adaptations. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 22 The returned Annual Quality Assurance Assessment (AQAA) confirmed the home had medication policies and procedures in place and these were held with the medication administration records. As a result of an inspection in one of their other homes, the owners had audited their present system to ensure that the procedures were being closely followed. A simplified step by step written instruction had been posted on the medication cabinet and the management team were monitoring that the system was being followed. The service users were expected to visit the office to receive their medication and bottled water and medicine pots were available so that medication could be easily given. After giving out the medication, the staff signed the medication sheets to show it had been given. Where medication administration records (MAR) were hand written, two staff had signed to say the recordings were accurate. The manager arranged for GP’s to review the medication for each person on an annual basis. Side effects of some medications were recorded so that staff would know what to look out for. The service users had signed to say they consented to staff giving them medication and these forms were held in the medication files. The drugs returned book showed that the pharmacist had signed upon receipt of drugs that were no longer needed. Medication was securely stored. All the staff had received accredited training in how to give out medication safely. In order to encourage independence, self-medication was promoted, subject to a risk assessment having been done. At the time of this visit, two service users were managing their medication, although it was still being kept in the office for safety reasons. During the visit, one of the service users came in, was given her medication from the cabinet and she signed the sheet showing she had taken it. Risk assessments were in place for both people. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Staff had received training in protection issues, so they would know what to do if they suspected service users were not being properly treated. EVIDENCE: The service user guide contained a copy of the home’s complaints procedure. And each service user had a copy. Their returned comment cards made it clear they knew how to complain or who to go to if they were unhappy about anything. Comments included, “I would speak to the staff or Linda”, “my key worker”, “Jenny Andrew (CSCI)”, “I would go to staff or advocate” and one person identified a specific member of the team whom she said “always listens to me”. There was a very open and inclusive culture within the home and everyone seemed to feel they could confide in or seek help and support from the staff and/or manager. We have not had cause to investigate any complaints in the home, since the last inspection. The home’s complaint book was checked and none had been entered since the last visit. Adult protection policies/procedures were in place and staff were not employed to work at the home unless all the right checks and references had been done. Inspection of service users’ files showed individual risk assessments were in place where vulnerability had been identified as a risk area. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 24 The Rochdale MBC Protection of Vulnerable Adult training had been done by the owner/manager, the other owner and the manager of Mornington House. Following this training, the manager at Mornington had done in-house training for the staff team and refresher training since this time had also taken place. In addition, all five support staff had done the Learning Disability Award Framework (LDAF) training which covered abuse, as well as having done at least their NVQ level 2 qualifications. Recently, staff had been circulated with a new induction training pack which they had been asked to complete and return to the manager. This included questions on abuse and it was to be checked and gone through at the next team meeting. The management team were knowledgeable about protection issues and recently when the team were experiencing problems in relation to a particular issue in respect of someone’s vulnerability, they had approached a social care professional who had worked closely with them during this time. Staff did not start work at the home until Criminal Record Bureau checks and/ or Pova First checks had been carried out. On an annual basis, one of the managers checked with each of the staff that they had not had any convictions in the year and they have then to sign to say this is correct. The statement is then held on their personnel file. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The owners had continued to make improvements to the house so that it provided a homely, clean, comfortable and safe place for the people living there. EVIDENCE: The house was a large four bedroom terrace, situated close to Heywood centre. Two lounges were provided on the ground floor, as well as a large dining kitchen. One of the lounges was non-smoking. Each service user had a good size bedroom with their own en-suite toilet and wash hand basin. Each person had a key to their rooms so they could lock their doors when they were out. The house was clean, comfortable, bright and airy and the layout enabled people to have space without having to always use their bedrooms. Local amenities were in walking distance and good public transport network was close to the home. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 26 The owners had a planned maintenance and renewal programme in place and it was evident this was being followed. Since the last inspection, several areas around the home had been re-decorated, a new kitchen had been fitted and new non-slip flooring supplied. In addition, the loft had been insulated, the central heating boiler replaced, new shower fitted and the bedrooms of each service user were being re-decorated and refurbished as needed. Three of the service users showed us their rooms and it was evident their choices in respect of colour schemes and décor had been taken into account. All three bedrooms were personalised to their own tastes. One was not yet completed but this was being addressed. Every other month, a home audit was done where equipment, lighting, appliances, etc., were checked. Following this, a report was done, identifying anything that needed to be put right. This ensured the home was kept well maintained. Infection control policies/procedures were in place and, since the last inspection, practices had improved with liquid soap and paper towels being supplied around the home, including the kitchen. In line with Environmental Health good practice guidelines, the home was completing a kitchen manual for food hygiene purposes. Disposable gloves and aprons were supplied and these were seen to be used. The laundry was situated just off the kitchen. Any soiled laundry was put into bags before being taken out of the front door and in through the back door, so that no cross-infection was possible. One of the service users said she always did this when taking her bedding to be washed. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The staff team had the collective skills, training and experience to undertake their roles efficiently and effectively which ensured the needs of the service users were being well met. EVIDENCE: Information contained in the Annual Quality Assurance Assessment document recorded a good age mix of staff and an all female, white British team of workers, reflecting the present service user group. From checking rotas and speaking to the staff, it was clear that staffing levels were flexible, dependent upon the individual activities that the service users wanted to do. The rotas were written taking into account the different activities that people wanted to do during the day and evening. One returned staff comment card said, “staff hours work around individuals’ needs and activities”. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 28 There had been no changes in the staff team for the past 15 months which meant that the service users had been able to build up trusting relationships with the staff who supported them. Interviews with the staff showed them to be enthusiastic, motivated and totally committed to their role and all felt they worked well together as a team. Staff interactions observed during the visit showed staff to be understanding yet firm when this was warranted. The key-worker system was working really well and service users could choose the person they wanted to support them in respect of their individual hobbies/ interests. Staff were happy with this flexible person centred way of working and said it worked well. Team meetings were regularly held and the minutes of the meetings showed them to be productive. Since April of this year, four had been held and the home was on target to complete six before their year end. The staff spoken to confirmed the meetings were always attended by the whole team and they felt they were a good way of ensuring they were all working in the same way with each of the service users. They also said they had regular one to one meetings with either the deputy manager or one of the management team. The Annual Quality Assurance Assessment (AQAA) recorded the home had a recruitment and selection policy in place. It was pleasing to note that no new staff had started work since the last key inspection in July 2006. A staff team that remained the same meant stability for the service users and they had been able to form good trusting relationships with the team. Staff files showed that, as part of the induction process, new staff were given copies of the General Social Care Council’s “Code of Practice”. The AQAA recorded that a new initiative had recently been introduced which was to involve service users in the recruitment process. As no new staff had started work, this was to be put into practice in the future, although one of the owners’ other homes had already started to involve service users in this process. The files of three staff were checked. All contained completed application forms together with two references and Criminal Record Bureau checks. The manager advised that a good practice initiative that had been introduced was to ask staff to declare on an annual basis that they had not had any Police involvement and this statement was signed and held on file. The three returned staff comment cards all confirmed that checks and references had been sent for before they had started working at the home. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 29 The owner/managers felt providing the right training opportunities to the staff was important, as this clearly influenced the outcomes for the people using the service. In order to encourage people to undertake courses, salary scales were dependent upon the qualifications that staff had attained. This coupled with the support workers’ desire to become qualified had resulted in a well qualified team of staff. All five had successfully attained their NVQ level 2 or above qualification. One support worker had recently completed her level 3 training and the deputy manager had done both her NVQ levels 3 and 4, although her level 4 had not yet been moderated. She was continuing with her training and had registered for the Registered Manager’s Award at Salford College. Evidence of training certificates was held in the individual staff personnel files. Comments received from returned staff questionnaires included, “all my mandatory training is kept up to date … and individual things around service users are always covered in in-house training”, “we are given excellent training”, “we are always thinking and discussing different approaches to give service users quality lives” and, “we have training in meeting the needs of people relating to disability, age, gender, etc., to give us a level of understanding of how to support the individual”. All five staff had completed their Learning Disability Award Framework induction training. The manager said this course which was a joint initiative between Health and Social Services was no longer available. She was reminded that, in the future, if new staff did not undertake this course, they should receive induction training to the Skills for Care standards. A recent training initiative introduced in the home, had been to circulate a new induction pack around the team which involved completing answers to set questions about issues in respect of good practice and safeguarding issues. One of the support staff was asked about this and commented, “I found it really good, it made me think about my practice”. A returned staff comment card said, “induction training was excellent” and another said, “some things you can only learn by experience”. The home had a training and development programme which included all mandatory training as well as more specialised training. Both in-house and external training courses were utilised. The staff training matrix showed all staff to have done the required training. New staff attended external training but refresher training was usually done in-house by using DVD’s or by someone having attended a specific training course who would then cascade the knowledge they had gained to the rest of the staff team. Questionnaires were completed following training, so that the manager could assess staff knowledge and awareness. The deputy manager had recently done training in respect of the Mental Capacity Act. One support worker was due to do refresher medication training at the beginning of December. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The management team was experienced, qualified and committed to ensuring that the service was meeting the needs of the service users. EVIDENCE: Both the owner/managers had undertaken the Registered Manager’s Award training as well as the Learning Disability Award Framework (LDAF) level 4 training in challenging behaviour. They had also done the LDAF assessors course and had kept themselves up to date with mandatory training courses. The home also benefited from input from the manager of one of the owners’ other homes in respect of advice and training on behavioural issues or other similar complex matters. The collective skills and expertise of the management team, including that of the deputy manager worked well in this small home setting. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 31 Feedback from returned staff comment cards and speaking to staff, indicated they felt the management team was supportive and dealt with issues as they arose. Comments received were as follows: “Service users come first in every way, staffing, finances, activities, home and decisions/empowerment”. “Communication is really good. We did have an issue with staff communication but we addressed it by having a team building session”, “Small things come up but are dealt with straight away so we can never complain”, “The company does everything to improve the service we offer to our residents”, “In my opinion the company are very caring and the home is run to very high standards in caring for service users and staff”. The home had an effective quality assurance system in place. They had a business plan from April 2007-March 2008, a rolling five-year maintenance programme and budget and a staff training and development programme. Investors in People had recently re-assessed the organisation and they had retained their award. Some very positive remarks about the management and staff team had been made. Quality questionnaires were regularly sent out to families and other visitors to the home and service user meetings were held. The minutes of some of these were seen and they showed that service users were able to discuss anything they wanted. Notes had been made about requests for bedroom themes and colours, staying unsupported in the house and that the smoking rules had been explained to everyone. Regular staff meetings and supervision sessions were arranged, as well as annual appraisals, which were currently being done. The manager of Mornington House also wrote an end of year report about the organisation and a copy of this report was sent to us. The providers have always co-operated with us in progressing any requirements within the agreed timescales and had made further improvements to the environment, which benefited the people living there. A new initiative, which has recently been set up by the manager/owners, is to hold action group meetings with the aim of looking at ways of further improving the service offered in all three of their homes. Also, an annual planner had been written showing dates for team meetings, service user meetings, supervisions and care planning reviews. The arrangements in place in respect of service users’ monies were satisfactory and the accounts are audited on a regular basis by one of the managers. Staff on sleep duty were responsible for doing daily checks of finances in order to ensure that everything was correct on handover. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 32 Information from the Annual Quality Assurance Assessment showed that all the necessary maintenance checks had been undertaken. Random samples of records relating to fire, gas and electrical appliances were all found to be up to date. The five year electrical check had been done on 6th February 2007. Health and safety checks of the building were done on a weekly basis and a more thorough house check was done monthly. Anything found to be unsafe was then recorded and reported on an action report and dealt with promptly. As stated above, all mandatory health and safety training for the staff was up to date. Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 33 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 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 3 x Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 34 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. Refer to Standard Good Practice Recommendations Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Apsley House DS0000058327.V354090.R01.S.doc Version 5.2 Page 36 - 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. 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