We carried out a review of the data available to us about Apple Grove on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Apple Grove, you can give feedback on this service.
People’s experience of using this service and what we found
There were systems in place to ensure staff were aware of risks of people choking. Risk assessments were reviewed and updated where required. Staff were kept up to date of any changes to people’s care plans and risk assessments. We observed staff following the care plans and risk assessments. Risks were discussed during team meetings and group supervisions. The provider also carried out checks on the staffs knowledge and competence.
People were protected by infection control policies and procedures. Staff had received training in
infection control and the correct use of personal protective equipment [PPE]. Specific risk assessments had been put in place to support people relating to COVID-19. We identified an area of the home which was cluttered making it difficult to clean, the deputy manager told us they would address this.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was not able to demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture. This was because the service had been originally set up as a campus setting. There were five other registered care homes set in the grounds of Somerset Court in close proximity to Cotswold House. The service was registered with us prior to the guidance being implemented. The provider had plans in place to address this and could demonstrate they were making progress.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 20 March 2019).
Why we inspected
We undertook this targeted inspection to check on a specific concern we had about staff following guidance relating to eating and drinking assessments. A decision was made for us to inspect and examine those risks. We also reviewed the infection control procedures as part of our current methodology.
We found no evidence during this inspection that people were at risk of harm from this concern.
Please see the safe section of this full report.
The overall rating for the service has not changed following this targeted inspection and remains good.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cotswold House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Cotswold House is a detached bungalow situated in the extensive grounds of Somerset Court which is owned by the provider. The home accommodates six people who have autism and complex support needs. At the time of the inspection six people were living at the home.
The service had not originally been developed and designed in line with the Registering the Right Support guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court near Cotswold House. The registered manager had personalised the service to reflect the Registering the Right Support Guidance.
People’s experience of using this service and what we found
People were supported by staff who had a very good understanding of managing risk safely. Records provided staff with clear guidance on how to manage specific risks such as choking. Staff were kept informed of changes to people’s risk assessments.
Specific risk assessments had been put in place to support people during the Covid 19 lock down, and for managing the return to socialising in the wider community safely.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff confirmed there had been learning following a choking incident in one of the providers other homes.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 18 March 2019).
Why we inspected
We undertook this targeted inspection to check on a specific concern CQC had about a choking incident. A decision was made for CQC to review how risk around choking and specific health needs was being managed. The information CQC received about the incident investigation indicated concerns about the management of choking. This inspection examined those risks and the management of health-related risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.
The overall rating for the service has not changed following this targeted inspection and remains good.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cotswold House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The home accommodates up to six people who have autism and complex support needs. The home comprises of the main building and three self-contained flats attached to the bungalow.
During our inspection there were three people living in the main part of the home and three people living in each one of the flats. People living at Cotswold House can access all other facilities on the Somerset Court site, which include a day service facility and gym.
The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Cotswold House. In total 37 people with learning disabilities were living at Somerset Court. It would be unlikely that we would register this model of services now when considering applications for services for people with a learning disability and/or autism.
People’s experience of using this service:
The values set out in the Registering the Right Support include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. This location may not be ideal for some people who would want to access the local community independently due to the rural area. However, people were given choices and their independence and participation within the local community was encouraged.
Staff knew what action to take if they suspected abuse. Relevant risk assessments had been completed to ensure people’s safety. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or themes.
People were supported to make choices and had control of their lives. Staff supported people in the least restrictive way as possible. This was kept under review. Staff were aware of the legislation to protect people’s rights in making decisions.
People were cared for in a way that respected their privacy, dignity and promoted their independence. Staff knew people well enabling care to be delivered effectively, responding to people’s changing needs.
Staff interactions with people were kind and caring. People were supported by staff that were familiar to them taking into their consideration their preferences. People had a core group of staff within the team that supported them on a day to day basis. This enabled people to build effective relationships and enable the staff to get to know them.
People received personalised care, their support needs and preferences were detailed in their care plans. People were supported to lead meaningful and fulfilled lives through activities of their choice. The provider had a complaints policy and process in place. Relatives said they would have no hesitation in speaking with the registered manager or staff. Staff knew people well and recognised when they were not happy with the care and support and made the necessary adjustments.
Systems were in place to monitor the service, which ensured that people's risks were mitigated and lessons were learnt when things went wrong. There was an open culture within the service, where people and staff could approach the registered manager, who acted on concerns and suggestions to make improvements to people’s care.
People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people felt included and their views were sought. The registered provider was aware of the importance of reviewing the quality of the service and was aware of the improvements that were needed to enhance the service.
Rating at last inspection: Rating at last inspection: Good (report published September 2016)
Why we inspected: This was a planned inspection based on the rating at the last inspection. We found the service continues to meet the characteristics of Good in all areas.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The home comprises of the main building and three self-contained flats attached to the home. During our inspection there were three people living in the main part of the home and three people each living in one of the flats. People living at Cotswold House can access all other facilities on the Somerset Court site which include various day services.
The service was last inspected in February 2014 and was compliant with the standards we inspected. This inspection was unannounced and took place on 24 and 25 August 2016.
There was a registered manager responsible for the service; at the time of our inspection the registered manager was absent from the service. 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. The provider had arranged for a temporary manager to cover in the registered manager’s absence.
There were sufficient staff available to enable people to take part in a range of activities according to their interests and preferences. The majority of people required a minimum of one to one staffing to help keep them safe. Staff duties were clearly allocated so people received the support they needed.
A recruitment procedure was in place and staff received pre-employment checks before starting work with the service.
Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.
People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.
People received their medicines when they needed them. Staff had received training in the management and administration of medicines and their competency in this area had been regularly reviewed to ensure their practice remained safe.
People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.
Where restrictions were placed on people, these were not always regularly reviewed to ensure they were the least restrictive option. People’s privacy was not always considered. People were asked for their consent before staff assisted them with any tasks.
People were supported by a caring staff team who knew them well. Staff morale was good and there was a happy and relaxed atmosphere in the home.
Routines in the home were flexible and were based around the needs and preferences of the people who lived there. People were able to plan their day with staff and they were supported to access social and leisure activities in the home and local community. There was an emphasis on enabling people to be as independent as they could be and to live a happy and fulfilling life.
There were effective systems in place to monitor and improve the quality of the service provided.
There were appropriate arrangements in place to assess people's capacity to make specific decisions such as a need for medical treatment. People were empowered to make choices about their daily living arrangements. Where people were assessed as not being able to make informed decisions best interests meetings had been held. Decisions had been made on their behalf in consultation and discussion with other professionals and people's representatives. People had access to independent advocates to help them in making decisions and ensuring decisions had been made in people's best interests.
Comprehensive assessments had been completed to ensure people received a consistent and reliable service. Parents we spoke with were all very positive about the care provided by the service. The service had a positive approach to risk. Assessments were in place to address potential risks to people's health and welfare and provide support to staff in responding and alleviating identified risks.
There were appropriate and safe arrangements for the administering and management of people's medicines. We saw there were individualised plans in place for the effective administering of medicines.
There were effective systems in place to monitor and review the quality of the service. The provider was proactive in learning from incidents and seeking support from professionals to alleviate risks to people.
People had a wide range of care needs. They were supported by a number of health and social care professionals. One person confirmed they were happy living at the home and felt well cared for. When we asked them who chose the things they did they said 'I do'. They said they 'liked the staff' who worked in the home.
People chose what activities they wish to take part in both inside and out of the home. They were supported to access a range of activities, outings to places of interest and to choose and attend holidays.
We saw that people were comfortable with the staff who supported them. None of the staff we spoke with had any concerns about any person being at risk and told us they felt the home was a 'safe place' for people to live. People who lived in the home could become distressed, anxious or present aggressive behaviour. Staff used approaches which were the least restrictive which helped to keep people's anxieties to a minimum.
The provider had various systems in place designed to monitor the quality of the service provided to people and to ensure people remained safe. Changes or improvements were made where possible. People's views were sought and listened to.