Archived: Appleton House

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.

People were able to bring some of their own belongings and pieces of furniture when they moved into the home. Their privacy and independence were respected. We saw, and we were told, staff were available to people when they needed them. People were supported to do activities when they wanted.

Staff were trained and knowledgeable about the importance of medication and there were robust systems in place to check and monitor standards of medicines management. There were effective recruitment and selection processes in place. People were cared for, or supported by, suitably qualified, skilled and experienced staff.

We spoke with two people living in the home who told us that they knew how to complain. One person said they had not had any reason to complain. The provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had taken steps to provide care in an environment that was adequately maintained.