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Options Applegate House Outstanding

A review of one or more of the ratings contained within the inspection report has been carried out at the request of the provider. Further to the review the ratings within this report have changed.

Reports


Inspection carried out on 23 June 2017

During a routine inspection

Applegate House is a care service providing accommodation and personalised support for up to six younger adults with autistic spectrum conditions, learning disabilities and complex needs, based in the local community of Barton-upon-Humber.

It is an autism specific transitional service where life-long learning can be developed further, including social and domestic skills, along with community and leisure facility access. Based on the philosophy of the organisation, ‘Fitting a service around you, not fitting you within a service,’ flexible staffing and personalised programmes enabled and promoted people to live as independently as possible. This philosophy was embraced by the staff team and drove staff practice in their delivery of care.

Accommodation is provided in six self-contained flats each with a bedroom, en-suite bathroom, kitchen/diner and lounge.

At the last inspection, the service was rated Outstanding.

At this inspection we found the service remained Outstanding.

We saw the provider was committed to personalising the services they provided and also to following the recommendations outlined in ‘Putting People First’ (a shared vision in transforming adult social care to put people first through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity.) and the Autism Act (2009). The service was accredited with the National Autistic Society (NAS), which drove best practice to deliver outstanding care to people who used the service.

There was a strong person-centred culture apparent within the service. Person centred means care is tailored to meet the needs and aspirations of each individual. Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks choosing particular actions over others, in order to support people to lead fulfilling lives in as ordinary a way as possible. In delivering this consistent approach people were supported to try new things and make positive changes in their lives. The provider, the registered manager and the staff team all had an excellent understanding of positive risk management and supported people that had previously challenged services to reach their full potential.

An outstanding feature of the service was the time invested developing the service to accommodate the changing needs of the people who used the service, using innovative and flexible ways to move people forward. The registered provider was seen to constantly adapt and strive to ensure people were able to achieve their full potential.

The registered manager demonstrated strong values and a desire to continue to learn about and implement best practice throughout the service and also shared their skills to support other registered providers to develop their services.

We found personalised programmes and flexible staffing arrangements enabled people to learn to live fulfilled and meaningful lives. Staff knew people well and were skilled at ensuring people were safe whist encouraging them to stretch their potential and achieve as much independence as possible. Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on least restrictive practice guidance to support people safety.

Robust systems were in place to protect people from the risk of harm or abuse. People who used the service were supported by staff who understood the importance of protecting them from harm. Staff had received training in how to identify abuse and report this to the appropriate authorities. Staff were recruited in a safe way and all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refr

Inspection carried out on 15 December 2014

During a routine inspection

We undertook this inspection on 15 December 2014 and the inspection was unannounced, which meant the registered provider did not know we would be visiting the service.

The service was last inspected on 6 September 2013 and was meeting all the regulations assessed during the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 15 May 2013. 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.

Applegate House is a community support service providing accommodation and personal care for up to six younger adults with a learning disability and autistic spectrum disorder. There were four people living at the service on the day of our visit. Applegate House consists of six individual self–contained flats each with a bedroom, en-suite bathroom, kitchen/diner and lounge.

Personalised programmes and flexible staffing enabled people to learn to live as independently as possible with the minimum of support. This was based on the philosophy of the organisation ‘fitting a service around you, not fitting you within a service.’

There was a strong person centred culture apparent within the service. (Person centred means care is tailored to meet the needs and aspirations of each individual). Personalised programmes and flexible staffing enabled people to learn how to live as independently as possible with the minimum of support. People told us they felt included in decisions and discussions about their care and treatment. Staff described working together as a team, how they were dedicated in providing person centred care and helping people to achieve their potential. Staff told us the registered manager led by their example and were supportive of them.

People lived in a safe environment. Staff knew how to protect people from abuse and they ensured equipment used in the service was regularly checked and maintained. Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s right to make decisions.

The registered provider had policies and systems in place to manage risks, safeguard vulnerable people from abuse and the safe handling of medicines. Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on best practice guidance and least restrictive practice to support people’s safety. This guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, when they lacked capacity, these had been made in the person’s best interests.

Recruitment practices were safe and relevant checks had been completed before staff commenced work.

People who used the service spoke positively about the care they received. People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided.

People’s nutritional and dietary needs had been assessed and people were supported to plan, shop for ingredients and to prepare their own meals. People spoke positively about the choice and quality of food available.

People were able to discuss their health needs with staff and had contact with the GP and other health professionals as required. The service made appropriate and timely referrals to healthcare professionals and recommendations were followed. People were supported to attend routine health checks.

There were sufficient staff on duty to meet people’s needs. Staff received training and support to enable them to carry out their tasks in a skilled and confident way. People who used the service were matched with staff who had similar hobbies and interests in order to support them with their preferred activities. These included; furniture restoration, radio, visiting radio stations, theme parks and voluntary and paid work placements.

Inspection carried out on 6 September 2013

During a routine inspection

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

The manager confirmed that they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held.

Comments included �Initially I didn�t want to move away from my home area, now I would happily be a hundred thousand miles away to be at this service. The staff are fantastic and really cannot do enough to help me and find solutions to any problems that I may be experiencing.�

�The staff are really nice; all of them.� and �The staff help us with things we can�t do ourselves, like when we are worried about something.� �We are able to choose our own key worker, and we are involved in interviewing them, so we can make sure they are the right person for the job.�

People were happy with the care they received and told us they saw a range of health professionals for advice and treatment. Comments included, "If I am ill, the staff will encourage me to see the doctor and support me to go there when this is needed.�

We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.

During a check of daily food safety records we found that although these had been completed and signed by staff, they had not always been signed for by senior staff.

We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.