Archived: Appleton House

Updated 8 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 April 2016 and was unannounced. The inspection team consisted of two adult social care inspectors.

The service was previously inspected on 7 January 2014 when it was found to be fully compliant with the regulations. Prior to the inspection we reviewed the Provider Information Record (PIR) and previous inspection reports. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the information we held about the service, previous inspection reports and notifications we had received. A notification is information about important events which the service is required to send us by law.

During the inspection spoke with six people who used the service, two relatives, five members of care staff, the registered manager, deputy manager and two health professionals. In addition we observed staff supporting people throughout the home and the support staff provided with people medicines. We also inspected a range of records. These included three people’s care plans, two staff files, training records, staff duty rotas, meeting minutes and the services policies and procedures.

Updated 8 July 2016

We inspected Appleton House on 27 April 2016, the inspection was unannounced. The service was previously inspected in January 2014 when it was fully compliant with the regulations. The inspection team consisted of two adult social care inspectors.

The service is registered to provide care and accommodation for up to seven people who have mental health needs. At the time of our inspection seven people were living at the service. There was 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.

People told us they felt safe and well cared for at Appleton House. Their comments included, “They are looking after us” and, “I do feel safe.” While staff told us, “People are safe.” Staff understood local procedures for the safeguarding of vulnerable adults and all staff had been provided with guidance on whistle blowing which included details of how to directly raise concerns with the provider’s chief executive.

The registered manager and staff knew people well and demonstrated throughout our inspection a detailed understanding of their individual support needs. Staff took pride in people’s achievements and recognised the benefits of supporting people to become more independent. One staff member told us, “People are looking for jobs and becoming more independent. One person has successfully moved to living independently and is doing well.” Staff actively encouraged people to be as independent as possible.

People told us they got on well with care staff and commented; “We do have a great laugh with some of the staff” and, “the staff are fine.” Staff enjoyed the company of the people they supported and there was clear comradery and friendly rivalry between people and staff in relation to sports and games played within the service. Staff told us, “I would say yes this is a good place for people to be” and, “I would say most people are happy most of the time.”

People’s care plans were highly detailed, informative and up to date. People had been involved in the development of their care plans and these documents provided staff with clear guidance on how to meet their individual care needs. Staff told us, “the care plans are accurate” and we found they contained informative sections on how people’s needs changed if they became unwell.

Physical restraint was not used at Appleton House and we observed staff successfully using techniques described within people’s care plans to help individuals to manage their anxiety during our inspection. People told us, “I can come and go as I want I have no restrictions” and we saw people were able to access the local community independently when they wished.

Risks had been clearly identified and staff had been provided with appropriate guidance on how to protect people and themselves from each identified risk. Where accidents and incidents had occurred they had been fully documented and investigated by managers. Where any learning or areas for improvement were identified as a result of these investigations action had been taken to further improve people’s safety.

The service had a full time activities coordinator and people were able to access a wide variety of recreational activities both within the service and in the local community. Staff told us, “We do the activities board each week with proposals for activities and then people choose whether or not to do it.” We saw people’s decisions not to engage with planned activities were respected by staff. The service’s lounge was equipped with a pool table and a wide selection of games. People told us, “Playing cards, playing pool we get enough activities in the home to do” and, “People enjoy themselves here, play games, do what you want. Pool or whatever you enjoy.” We observed friendly competition and mutual respect between people and staff as games were played in the service’s lounge.

People’s privacy and dignity was consistently respected. People held keys to the service’s front door and were able to lock their own rooms if they wished. In addition we observed that staff delayed cleaning tasks within the service’s shared areas until they were sure everyone was awake to avoid unnecessarily disturbing people who had chosen to sleep in.

There were sufficient numbers of suitably trained staff on duty to ensure people’s care and support needs were met. Our analysis of the staff rota for the month prior to our inspection found the service had been consistently staffed at a safe level and that the registered manager hours were protected to allow them to focus entirely on their managerial duties. The provider had appropriate systems in place to ensure that service was appropriately staffed during periods of staff leave or sickness.

Recruitment procedures were robust and new staff received formal induction training and observed practices within the service for a significant period before they were permitted to provide support independently. Staff told us, “I get a lot of training”, “the training is brilliant here” and “new staff get a lot of shadowing it is more like an apprenticeship really, That’s how they learn.”

Staff told us, “The registered and deputy managers are both very supportive, with our management team I think we are very lucky” and we found the staff team were well motivated and proud of people’s achievements.

The provider actively encouraged staff to continue their professional development and provided a management development programme which three staff were engaged with at the time of the inspection. This provided staff new to leadership, responsibilities with targeted training and support. One staff member involved with this programme told us, “I have never felt uncomfortable or out of my depth, the training has been really helpful”.

People were comfortable making complaints or providing feedback on the service’s performance. Where complaints were received they were investigated promptly and appropriate actions were taken to address and resolve the concern. Monthly residents meeting were held at the service and the minutes of these meeting showed that people’s feedback was valued.

The registered manager completed regular audits to monitor the service’s performance and twice a year a detailed quality assurance visit was completed by the provider. A report was produced on the findings of each visit and the registered manager developed a detailed action plan to ensure all issues identified were addressed and resolved.