Appledown

About the service

Appledown is a residential care home providing personal care for up to 6 people. At the time of the inspection the service was supporting 6 people.

People’s experience of using this service and what we found

Right Support

The service’s kitchen was dated and worktops and flooring were damaged and difficult to clean. Staff recognised this environment did not provide a positive environment to support people in developing new skills.

Following feedback, action was taken to make improvements to the kitchen environment prior to its planned replacement in the summer of 2024.

We have recommended the provider implement additional systems to ensure the service’s environment consistently supports people’s wellbeing.

People received their medicines as prescribed. However, we have recommended the service seek guidance on how to monitor the conditions in which medicines are stored.

People had choice and control in 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. People were supported effectively to make meaningful decisions and choices.

People were supported to access medical appointments and regular heath checks. People were encouraged to act upon advice from health professionals but were able to make unwise decisions.

Right Care

People had told us they felt safe and staff responded promptly to people’s requests. Staff had a detailed understanding of people’s individual needs and enjoyed their role in supporting people to be as independent as possible.

People were protected from all forms of abuse and discrimination by the dedicated staff team. The service had enough skilled staff to meet people’s needs and keep them safe.

Right Culture

People and relatives were complementary of the service’s compassionate culture. The staff team were well trained and dedicated to meeting people’s needs. Staff knew people well and were able to communicate effectively with people using appropriate aids as necessary.

Managers provided effective leadership, guidance and support to the staff team.

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 28 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Appledown on our website at www.cqc.org.uk.

Recommendations

We have made recommendations about the storage of medicines and the management of the service’s environment.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

People were supported by staff that were caring, compassionate and treated them with the utmost dignity and respect. Any concerns or worries were listened and responded to and used as opportunities to improve.

People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life history, and their communication needs. They used this information to develop positive, meaningful relationships with people. People's care plans were detailed and up to date about their individual needs and preferences. We recommend the provider consider also developing summary care plans in an easy read format, which would be more accessible to people.

Improvements in staffing levels meant people had more opportunities to pursue their individual interests, hobbies and go out more often, especially at weekends. Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. Environmental improvements had improved access and reduced risks of slips, trips and falls for people.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. People’s health had improved because staff worked with a range of healthcare professionals and followed their advice. Where people lacked capacity, staff worked with the local authority to make sure they minimised any restrictions on people’s freedom for their safety and wellbeing.

People, relatives, staff and professionals gave us positive feedback about improvements in the quality of people’s care. Quality monitoring systems had improved, with examples of continuous improvements made in response to audits, observation of practice and regular checks of the environment. People, their relatives and staff told us the registered manager was approachable, listened to them when they had any concerns and acted on feedback.

Rating at last inspection: Requires improvement. (report published 10 November 2017)

Why we inspected: This was a planned comprehensive inspection based on the rating of requires improvement at the last inspection. Following the October 2017 inspection, the provider sent us an action plan which set out the improvements being made to meet the relevant requirements. At this inspection, we found the previous breaches had been addressed and the service had improved to a rating of Good overall.

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.

Appledown is a care home which offers care and support for up to six people who have a learning disability. At the time of the inspection there were five people living at the service.

People were relaxed and appeared to be happy with each other and the staff who supported them. There were not sufficient staff available to provide personalised support to people at the weekend. For example, one staff member provided support to five people throughout the day. One person was supported by another staff member to go out and do activities. The registered manager told us these weekend staffing arrangements were normal. That is, one member of staff worked at the weekend to support four people. This meant people’s choice of how they spent their time was restricted. There were no opportunities for people to take part in individualised activities outside of the service due to the low numbers of staff. Activities and pastimes were arranged around the needs of the group rather than the individual.

The service was not meeting the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

We walked around the service and saw it was comfortable and personalised to reflect people's individual tastes. However, we found maintenance issues such as a lack of an appropriate window screen on a bathroom window which overlooked the main lounge, an unkempt garden which had a partially filled pond with a sharp drop off from the garden and an unfinished wooden balcony that required further work to finish it. We saw a broken toilet seat in a bathroom which a person told us had been broken on a number of occasions but not been appropriately fixed or changed. Maintenance checks were required for thermostatic mixing valves on two taps to ensure consistency of the water temperature.

Recruitment processes were generally safe and effective; however, we found appropriate pre-employment checks had not been completed for one staff member recently employed by the service. An informal arrangement had been put in place for a member of a person’s day placement staff to support a person who had recently moved into the service. We have made a recommendation about this.

Four of the five people who lived at Appledown had individual support plans and these were reviewed regularly with input from the people who were supported and their families. One person who had recently moved into Appledown did not have a needs assessment, care plan or risk assessments. The registered manager provided evidence that a multi-professional review meeting had been scheduled in respect of this person and explained that the commissioning assessment had proved to be inaccurate regarding the person’s needs, which was why formal records had not been completed until the review had taken place. This meant the person did not have accurate records to support and guide staff to provide appropriate support and care. We have made a recommendation about this.

The service did not have comprehensive quality assurance processes to ensure the consistency of the service. For example, required maintenance and records relating to people’s personal monies had not been appropriately audited. We checked the accuracy of money held by the service and saw this was a recording issue and not a financial loss of monies.

People were treated with kindness. Staff demonstrated they had a good knowledge of the people they supported. People had regular routine access to health and social care professionals where necessary. People attended an annual health check with a GP and had access to specialist medical services to ensure their health needs were met.

Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber's instructions.

Meals, snacks and drinks were chosen by people, which we saw they enjoyed. People had been included in planning their own menus and their feedback about the meals in the service had been listened to and acted on. Some people were actively involved in meal preparation.

Visitors told us they were always made welcome and were able to visit at any time. People were able to see their visitors privately if they wanted to.

The service had clear complaint systems and people had regular opportunities to discuss how they felt about the service. Each person had a key-worker who checked regularly if people were happy or wanted to raise any concerns. A relative told us, "I can talk to the manager anytime I need to. It is a small place and very informal but if there are any issues the [registered manager] sorts it out.”

Staff were supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe? Yes, at the time of this inspection we judged the service was safe.

People we spoke with were positive about the staff who worked at Appledown. People told us staff were 'very nice'. We observed staff were professional and supportive.We spoke with professionals who had visited the home. People told us, 'Appledown is a very good home. People are well cared for and supported here as far as I am aware'. Another professional who visited the home told us, 'In my opinion this is one of the better services of this type that I visit. It always seems friendly and a happy place'.

The service had a well organised medication system. The system was well managed and regularly audited. Records were accurate and up to date.

Is the service effective? At the time of this inspection we judged the service was effective.

People all had individual care planning records, which set out their care and support needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their relatives' needs and responded promptly when they needed assistance. People told us and we saw in peoples' records, that they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians.

Is the service caring? Yes, at the time of this inspection, we judged the service was caring.

Relatives of people who used the service, and external professionals such as social workers and relatives of people who lived at Appledown said they were happy with how the service supported people and found the staff to be professional and helpful. A relative told us 'it is very good. I have no concerns.' Care staff we spoke with told us, 'Appledown is a real home from home. In my opinion, the overall standard of care and support for people is excellent'.

From our conversations with people who had experience of the service and a review of the records we assessed, we judged that individuals wishes and needs were taken into account and respected.

Is the service responsive? Yes, at the time of this inspection, we judged the service was responsive.

Everyone we spoke with said the staff treated people with respect and dignity. We observed staff were kind and respectful of each person who lived at Appledown. People told us and we saw from records that people were able to be involved in a wide range of activities both at Appledown and also in the community. These included dance classes, visits from a hairdressing service and annual holidays chosen by each person and facilitated and supported by staff at Appledown.

From our conversations with relatives, and management, staff and other professionals we formed the view that the service was diligent about ensuring they could meet the changing social and support needs of each person supported.

Is the service well-led? Yes, at the time of this inspection, we judged the service was well led.

Staff, relatives and external professionals were all positive about the management of the service. People told us management would listen to staff and also to any concerns raised by people who lived at Appledown and/or their relatives and were supportive. All staff members we spoke with commented positively about the management of the home. One person told us, 'It is fantastic. The manager is really very good in the way the home is managed and the support and care she offers to everyone at Appledown including the staff as well'.

Appledown had a system to check people were happy with the service. This included systems of survey and audit. There was also a system to monitor accidents and incidents. People's personal care records, and other records kept in the home, were accurate and complete.

We saw the home was comfortable and clean. We observed each person had individualised their own room to suit their personal taste. People we spoke with told us they were encouraged to choose how they spent their time and had free choice about areas of their life such as when they went to bed and what choice of meals they had. We saw people engaged in various activities during the day. People were happy to spend time socialising together, talking with staff and visitors to the home or spending time in their own pursuits. We saw people moved around the home with no restrictions.

We found there were suitable arrangements in place for obtaining, and acting in accordance with, the consent of people who lived at Appledown in relation to the care and treatment provided for them.

Appledown had a choice of suitable and nutritious food and hydration, in sufficient quantities to meet service users' needs.

Appledown operated effective systems designed to assess the risk of and to prevent, detect and control the spread of infection.

People who lived at the home were safe and their health and welfare needs were met by staff that had been appropriately recruited and were appropriately qualified, skilled, experienced and of good character.

We spoke to an external professional who worked closely with the staff. Comments included, 'the staff are very, very caring' and 'what I really like is they know there clients very, very well'.

We saw staff talk with people who lived at Appledown and observed that they were respectful, friendly and supportive of them. The atmosphere in the home was warm, welcoming and there was a sense of fun. Observation of people's interactions with staff told us people felt involved and safe.

From our inspection we found that people experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that appropriate checks were undertaken before staff began their employment at Appledown.

People who used the service, their representatives and staff were asked for their views about their care and treatment, and they were acted on.