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Inspection carried out on 8 March 2018

During a routine inspection

The Apuldram Centre is a supported living service and domiciliary service that provides care and support to adults of all ages in their own homes. The service provides help with people's personal care needs in Chichester and the surrounding areas. This includes people who may have a learning or physical disability as well as people living with sensory impairment.

The Apuldram Centre provides care and support to people living in a 'supported living' setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

The service supports some people on a 24 hour basis and others who may require support with personal care needs at specific times of the day and/or night. At the time of this inspection, ten people received support with their personal care needs from the agency.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values 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.

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 the last inspection, the service was rated Requires Improvement. At this inspection we found the service was now rated Good.

Why the service is rated Good.

The service was now safe. At the inspection in September 2015, we found the provider was in breach of a Regulation associated with the safe management of medicines. We asked the provider to take action to ensure medicines procedures were safe and to send us an action plan of how and when this was being addressed, which they completed. At the inspection in October 2016 we found some improvements had been made to the safe management of medicines, but we also found the provider had not taken sufficient action to ensure medicines were safely managed at all times. The report highlighted that people were supported with their medicines, but records of medicine stocks were unclear and did not match the quantities we checked. At this inspection we found that the provider had followed their action plan and that steps had been taken to ensure the breach was met.

People’s medicines were now managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received medicines training and understood the importance of safe administration and management of medicines.

The PIR states; “Apuldram is committed to keeping the people who it supports, staff and volunteers safe. Our policies and procedures set out the way in which we work.”

The service was now well-led. At our inspection in October 2016 it recorded that at the time of our inspection there was no registered manager in post. It also highlighted that quality and safety of the service was audited but this had not always identified shortcomings in the safe management of medicines as required in the last report. At this inspection we found there was now a registered manager in post and the breach concerning medicine quality checks had now been met.

The provider had systems in place to monitor, assess and improve the service. There was an open culture, and people, relatives and staff said they found access to the office and management team welcoming and easy. Staff were positive and happy in their jobs. There was a clear organisational structure in place.

People able to, when asked, told us the service they received was safe. People

Inspection carried out on 20 October 2016

During a routine inspection

The inspection took place on 20 October 2016 and was announced.

The Apuldram Centre provides personal care in a setting called ‘supported living’ in three houses in the Chichester area. At the time of the inspection personal care was provided to five people in the three ‘supported living’ houses. ‘Supported living’ is a scheme whereby people have their own tenancy to live independently with care and support provided by a choice of provider.

At the last inspection of 1 September 2015 we made three legal requirements where the provider was not meeting the regulations. These were regarding the management of medicines, procedures for the use of the Mental Capacity Act 2005 and a failure to notify the Commission of a change to the nominated individual for the provider. The nominated individual is the person employed as a director, manager or secretary for supervising the management of the service. The provider sent us an action plan to say how and when these regulations would be met. The Commission have been notified of a new nominated individual. The service now has policies and procedures regarding the Mental Capacity Act 2005 and staff have received training in this. The inspection highlighted that a ‘best interests’ decision had been made on behalf of one person prior to the person’s capacity being assessed regarding the decision in question. The nominated individual recognised this should have been completed and confirmed this was completed following the inspection. The regulation regarding the safe management of medicines was still not fully met at this inspection.

At the last inspection the service had a manager who completed their registration with the Commission following the inspection. This person has now left the service. The Commission were notified of these changes and the interim management of the service, which was being provided by the nominated individual and a care coordinator. The provider was in the process of recruiting a manager who would apply for registration with the Commission. However at the time of our inspection there was no 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.

Medicines were not safely managed as there was an excess of medicine stocks for one person and which the staff and management could not account for. Records showed that other people received their medicines as prescribed.

Staff had a good awareness of how to keep people safe and knew what to do if they had concerns or if they considered someone was being abused. Relatives, staff and a health and social care professional said the service provided safe care to people.

Risks to people were assessed and care plans included details of how staff should keep people safe.

Sufficient numbers of staff were provided to meet people‘s needs. Pre-employment checks were made on newly appointed staff so that only people who were suitable to provide care were employed.

People received care from staff who knew people’s needs well and were able to communicate effectively with people so they could provide care in the way people preferred. Staff training and supervision has improved and is more organised than we found at the last inspection. Staff had access to a range of relevant training courses and said they were supported in their work.

People were involved in choosing and cooking their meals. This was done with the support and guidance of staff so people had a healthy diet.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks.

Staff had positive working relationships with people and demonstrated a car

Inspection carried out on 1 September 2015

During a routine inspection

This inspection took place on 1 September 2015 and was announced

At our last inspection on 22 July 2014 we found the service was in breach of a regulation as staff did not receive adequate supervision with their line manager. The provider sent us an action plan on 8 September 2014 to say this was addressed and that each staff member would be supervised every eight weeks. At this inspection we found staff supervision was taking place and this requirement was now met.

The Apuldram Centre is registered to provide personal care to people with a learning disability in a supported living environment. These are people’s own homes where they receive care and support to live independently. At the time of the inspection one person received personal care from the provider. The service also provided support, but not personal care, to other people. Twelve staff were involved in the provision of personal care. The provider also ran a horticulture scheme and craft centre which people attended. This included a café and shop. This part of the service was not inspected as it does not fall within the Commission’s scope of registration.

The service had a registered manager but this person was no longer working for the provider as they had left the post in August 2015. 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 notified us of these changes and were in the process of recruiting a manager who would apply for registration with the Commission. At the time of the inspection there was an acting manager for the service. The provider had not notified us of the change of the nominated individual for the organisation. The nominated individual is the person notified to the Commission as responsible for supervising the management of the personal care of people.

Procedures for the storage and administration of medicines were not always safe. There were a number of different stocks being used and the quantity of medicines in stock did not correspond with the stock records. A risk assessment had not been completed regarding one person having access to their medicine.

The service did not have written policies and procedures regarding the Mental Capacity Act 2005 and staff were not trained or aware of the legislation. This included the assessment of capacity when people did not have capacity to consent to care or treatment, or, when people might be deprived of their liberty for their own safety.

Staff had a good awareness of how to keep people safe and knew what to do if they had concerns or if they considered someone was being abused. Relatives, staff and a health and social care professional said the service provided safe care to people.

Sufficient numbers of staff were provided to meet people‘s needs. Pre-employment checks were made on newly appointed staff so that only people who were suitable to provide care were employed.

People received care from staff who knew people’s needs well and were able to communicate effectively with people so they could provide care in the way people preferred. Staff had access to a range of relevant training courses and said they were supported in their work.

People were involved in choosing and cooking their meals. This was done with the support and guidance of staff so people had a healthy diet.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks.

Staff had positive working relationships with people and demonstrated a caring attitude. Cultural and religious needs were taken account of by supporting people who wished to attend religious services.

Staff were familiar with people’s needs and supported people in the way people preferred. Whilst people were limited in their ability to be involved in their assessments and care plans, these were recorded with people’s needs and preferences as central to how care was provided. This is called person centred care.

Staff, people and relatives met every three months to discuss people’s care needs. Relatives told us this gave them an opportunity to raise any issues about changing care needs or any concerns they had. Relatives said any concerns raised were promptly acted on.

People were supported to attend a range of activities including supported employment, social activities, holidays and outings.

Staff were committed to their work and demonstrated values of compassion and respecting people. The service had an open culture where people and relatives were encouraged to communicate with the service’s management.

A number of audit tools were used to check on the effectiveness, safety and quality of the service. This included seeking the views of people, relatives and stakeholders such as health and social care professionals.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 22 July 2014

During a routine inspection

The Apuldram Centre provides a domiciliary care service, a supported living service and a training centre to people with learning difficulties. The domiciliary care service is registered with the Commission and was the subject of this inspection. We were informed that one person was receiving this service.

This inspection was carried out by one inspector. We gathered evidence that helped us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with the person using the service, their relative, one of the staff supporting them and from looking at a selection of records. They included care assessments and care records, records of medicines administered, staff training records and records related to the provider's quality assurance system.

Is the service safe?

Staff had received training in identifying and reporting possible abuse. This meant the provider had taken appropriate steps to guard against the risk of being abused.

They had also received other training that provided them with appropriate knowledge and skills about how personal care should be delivered safely and to an appropriate standard.

The manager was unable to provide evidence of staff appraisals or that staff had received supervision in accordance with the provider�s own policy. This meant that staff who were expected to deliver personal care may not have been appropriately supported to ensure the safety of people using this service. We have set a compliance action in relation to this and the provider must tell us what they are going to do to address it.

The provider had a system in place for gathering, recording and evaluating information about the quality and safety of the care and support the service provides.

The manager and the care staff demonstrated how medicines prescribed to individual people had been stored and administered safely.

Care records had been appropriately maintained and reviewed to ensure people's needs had been met safely.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. This ensured care delivered had taken into account people�s wishes and preferences.

We spoke with the person who received personal care who confirmed they were happy with the care provided. They told us, �I happy here!� We also spoke with their relative who said, �We absolutely feel that The Apuldram Centre is a service where X has grown and will be as independent as they can be.�

Is the service caring?

From our observations we saw people were treated with respect and dignity by the staff.

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People and family members who completed satisfaction surveys reported they had no concerns about the care provided.

Is the service responsive?

Staff supported people to talk about their views and experiences and to sort out any problems.

People and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed. A relative told us about concerns they had with regard to money that had been spent, �When I spoke to the manager, they showed how they money had been spent and I was reassured.�

Is the service well-led?

The service had a quality assurance system. Records that we looked at showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff we spoke with were able to describe their roles and responsibilities and what they were expected to do.

They also confirmed they felt well supported by the manager.

Inspection carried out on 15 November 2013

During a routine inspection

We were informed that, currently, one person received personal care from The Apuldram Centre. This person agreed to speak with us, but requested that the manager was present. This was because the person was not confident when they met with someone for the first time and needed assistance from someone they knew.

They confirmed they were happy with the care and support that had been provided. They also told us that the care workers were very good and understood how they liked to be prompted and helped. They informed us, �I can talk to the staff. They will listen to me.�

We also gathered evidence of people's experiences of the service by looking at a selection of records. They included care records, medication records, staff recruitment records and records of audits conducted by representatives of the provider. We found that generally records we looked at were up to date and well maintained. However, in some instances there were gaps in medication administration records, which meant the person may not have received prescribed medication. Audit records did not include how the delivery of personal care had been assessed and monitored to ensure the quality of service provision. This meant that people may not have received care that was safe and appropriate.

Inspection carried out on 20 February 2013

During a routine inspection

People told us they were involved and had a choice in respect to the support that they received. People and their relatives felt able to raise issues or concerns with the centre's management and felt confident that they would be dealt with appropriately. One person who used the service told us "I am very happy here". Another person we spoke with told us that "staff are very supportive and help me to do things that I want".

People told us that the support that they received was provided in a flexible way. One person said "I ring them up if something out of the ordinary happens and I need their help". The relative that we spoke to told us "I can speak to someone with any issues no matter what time of day or night it is". People told us that the supported living manager from the service attended their home regularly to check on the progress of their care plan and ask about any changes that needed to be made.

We spoke with the registered manager, the supported living manager and one staff member during our visit. The staff member told us that they were very happy working for the company. They said that they were supported by the management team and had received the training and supervision they required to ensure they could meet individual people's needs.