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Inspection carried out on 4 September 2018

During a routine inspection

The inspection took place on 4 September and was unannounced. The inspection continued on 5 September 2018 and was announced.

Applelea is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation for persons who require nursing or personal care. It is registered for up to four people with learning disabilities and autistic spectrum disorder. At the time of our inspection there were four people living in the home.

The home was a two storey detached property which had an open plan kitchen dining area, and one bedroom on the ground floor. On the first floor there were two further spacious en-suite bedrooms and a lounge. There was also a single self-contained annex and enclosed garden.

The care service had been developed and designed in line with the values that underpinned the Registering the Right Support and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of seizures or behaviours which may challenge the service, staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

Where possible people had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People’s eating and drinking preferences were understood and their dietary needs were met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff. A co

Inspection carried out on 11 December 2015

During a routine inspection

This unannounced inspection of Applelea took place on 11 December 2015. The home provides accommodation and support for up to four people who have learning disabilities or autism. The primary aim at Applelea is to support people to lead a full and active life within their local community and continue with life-long learning and personal development. The home is a detached house, within a residential area, which has been furnished to meet individual needs.

At the time of the inspection there were four people living in the home. People had their own en-suite bedrooms which had been specially adapted to meet their needs. Since our last inspection a conservatory had been added to provide a sensory room and space if people wished peace and quiet or somewhere to calm their anxieties. There was a large rear garden with an extensive lawn to which people had constant access.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Relatives and an advocate told us staff always provided reassurance when people were anxious and made them feel safe. Staff had completed safeguarding training and had access to current legislation and guidance. Staff had identified and responded appropriately to safeguarding incidents to protect people from harm. People were safeguarded from the risk of abuse as incidents were reported and acted upon.

Risks to people had been identified in their care plans and measures were implemented to manage these safely. Staff were able to demonstrate their understanding of the risks to people’s health and welfare, and followed guidance to manage them safely. People were kept safe by staff who understood people’s risk assessments and management plans.

During our inspection we saw there were enough staff to respond immediately when people required their support. Staff had time to devote their full attention to people and focus on their individual needs. There were sufficient numbers of staff deployed with the necessary experience and skills to support people safely.

Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff. This ensured they had the appropriate knowledge and skills to support people effectively. Staff had undergone required pre-employment checks, to ensure people were protected from the risk of being supported by unsuitable staff.

Medicines were administered safely in a way people preferred, by trained staff who had their competency regularly assessed by the provider. The registered manager reinforced this training by discussing issues related to the safe management of medicines during all staff supervisions. Medicines were stored and disposed of safely, in accordance with current legislation and guidance.

People and their relatives and advocates told us they were actively involved in making decisions about their care. Staff supported people to identify their individual wishes and needs by using their individual methods of communication. People were encouraged to make their own decisions and to be as independent as they were able to be.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had completed the required training and was aware of relevant case law. Since the last inspection the provider had made four DoLS applications. The registered manager had taken the necessary action to ensure people’s human rights were recognised and protected.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, protecting them from harm and promoting their dignity.

People’s dignity and privacy were respected and supported by staff at all times. Staff referred people to relevant healthcare services promptly when people’s assessed needs changed.

The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme ensured people were supported to pursue social activities which protected them from social isolation.

Relatives told us they had no reason to complain but knew how to do so if required and that the staff r encouraged them to raise concerns. Two complaints had been made since the last inspection which had been dealt with in accordance with the provider’s policy. The registered manager listened to people’s comments and implemented identified learning from incidents and accidents.

Staff understood the values of the provider, which we observed being demonstrated in practice. The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements.

Records accurately reflected people’s needs and were up to date. Staff were provided with necessary information and guidance contained in detailed care plans and risk assessments to meet people’s needs. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons.

Inspection carried out on 15 February 2014

During a routine inspection

The people who use the service were not able to verbally communicate with us, or had very limited ability to do so. Therefore we spent time observing interactions with the staff and the people using the service to determine how their needs were being met and to understand their individual experience of the service. We also observed a number of activities being undertaken and how these activities were carried out.

We saw people’s care records were person centred meaning that they were contained personal and up to date information specifically about the person and their needs and choices about their care. The care records had the information in them that staff required to support the people appropriately. We spoke with representatives of people using the service and they told us that they were invited to reviews of their relative’s care.

During the inspection we spoke to the staff on duty. We found the staff to be supportive and caring of all of the people and they had a good understanding of their care and support needs. We observed the staff and their interaction with people and saw that they arranged activities to suit each person’s needs. Staff had received the appropriate training to support the people, many of whom could not verbally communicate their wishes.

The staff we spoke with had knowledge of the mental capacity act and were able to explain how they attempted to gain consent to care and treatment from people using the service. We saw that there was a variety of activities planned the meet the needs of people using the service and that the people were able to choose whether or not they wanted to take part in the activities. If people chose not to engage then staff helped them to choose other things to do. A representative of a person using the service told us “I am fully consulted on all decisions needed to ensure the welfare of my relative”.

Staff were able to talk with us about the provider’s adult safeguarding procedures and how to report concerns. This meant that they were able to recognise suspected harm or abuse and what action to take to reduce the risk of harm and how to deal with it if it happened. The representatives we spoke with told us that the provider maintained a safe environment.

The premises were clean and tidy and safety equipment was in place and had been tested regularly. Evacuation plans for each resident were recorded and on their personal file. Representatives of people using the service told us that a number of improvements had been made to the premises in the last year.

We saw that the provider had procedures in place to manage and investigate complaints and concerns about the service. The records we saw confirmed that any complaints and concerns were properly looked into and responded to. Suggestions about how the service could be improved were also dealt with properly. The representatives of people using the service told us that they receive feedback forms from the provider and on them they can make a complaint or suggestion about improvements to the service.

Inspection carried out on 5 December 2012

During a routine inspection

People living at Applelea had complex needs and were not able to tell us what they thought about the support and care provided. One person was offered the opportunity to talk to us but decide that they did not want to.

We were able to observe staff being responsive to the needs of the individuals in a respectful and supportive way that was in keeping with guidance in the support plan.

We observed staff supporting individuals to access different areas of their home which included their bedrooms or the kitchen.

Staff were quick in their response to individual’s requests and offer support if they were unhappy. We observed staff supporting an individual who appeared distressed offering them the opportunity to use pictures to let staff know what it was making them unhappy.

Reports under our old system of regulation (including those from before CQC was created)