SeeAbility - Applewood Residential Home

Seeability - Applewood Residential Home is a residential care home providing personal care for younger people with learning disabilities, mental health or autism support needs. There were five people living there at the time of inspection. The service was primarily for people who had sight impairments, however not all people had this support need.

Four people’s bedrooms were based in the main part of the house, some with ensuite facilities and others with a communal bathroom. Another person had their own self-contained flat built into an annexe attached to the house. There were communal areas that all people could use, as well as a large, well- maintained garden.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Although people didn’t tell us they felt safe, they appeared comfortable and relaxed around staff and calm when receiving support. Risks were managed in a positive way, enabling people to do the things they wanted to and be independent. There were enough staff to meet people’s needs and they were recruited in a safe way. Medicines were also given safely by trained and competent staff. When incidents occurred, these were reviewed for patterns or trends and actions taken to prevent reoccurrence.

People were supported to have maximum choice and control of 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’s nutrition and hydration needs were met and they were supported to have positive wellbeing by a number of health and social care professionals. The building had been effectively adapted to ensure that it met the needs of all people. Staff had the induction, skills and knowledge to ensure that they knew how to work with people and meet all of their support needs.

We observed that positive relationships had been built between people and staff and relatives told us they thought staff were kind, caring and attentive. Staff had a good understanding of respecting and promoting people’s dignity and privacy. We saw examples throughout the inspection of people being encouraged to be as independent as possible. This included the use of specialised equipment for those with a visual impairment.

People continued to be supported to do activities of their choosing, that suited their hobbies and interests. They were encouraged to maintain relationships with those that were important to them. Staff knew people’s communication needs well and used a variety of tools to ensure this was encouraged and promoted. Complaints had been managed in a professional and efficient way. Outcomes were shared and complainant’s views about the complaint’s process considered important.

Relatives and staff spoke highly about the registered manager and felt the service was well-led. We could see that the registered manager knew people very well and promoted a positive, person-centred work ethic. The registered manager had good oversight of the service and sought feedback from others to continuously improve. They understood the importance of working together with others to achieve positive outcomes for people.

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 16 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager. 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.

We met and spoke to all five people during our visit. People were not all able to fully verbalise their views and used other methods of communication, for example pictures and symbols. We therefore spent some time observing people. One person said; I enjoy it here.” And another said; “Staff support me when I get upset.” A staff member said; “Good company to work for.”

A relative wrote to the service and said; “The support and help given to my relative at Applewood is outstanding and has given him more independence than we ever thought possible. We fought hard for his place there and are continually surprised by his achievements. Well done and thanks to all at Applewood.”

People’s medicines were managed safely. Where errors had been found, action had been taken to reduce the risk of recurrence. Medicines were stored and disposed of safely. Staff received appropriate training and understood the importance of the safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as psychiatrics.

People who were able said they were happy with the care the staff provided. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives.

People’s care records were detailed and personalised to meet their individual needs. Staff understood people’s needs and responded when needed. People were not all able to be fully involved with their care plans, therefore family members supported staff to complete and review the care plans. People’s preferences were sought and respected.

People had their privacy and dignity maintained. Staff were observed supporting people with patience and kindness.

People’s risks were well documented, monitored and managed to ensure people remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input in preparing some meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

The registered manager and registered provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People who required additional support had one to one staffing when they needed it. Staff confirmed there were sufficient staff to meet these requirements. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received a comprehensive induction programme when they started work. People were protected by the company’s safe recruitment procedures.

People’s opinions were sought formally and informally. There were quality assurance systems in place. Feedback was sought from people and their relatives to assess the quality of the service provided. All significant events and incidences were documented and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff.

One person told us 'Staff never shout. I feel safe here'.

Another person told us they had a key worker and said 'I talk to my key worker about all sorts of things, about everything really'.

Staff members we spoke with told us that as part of their recruitment they had been interviewed by management and people who lived at the home. They told us they had provided references and identity and security checks had been completed before they started work. They told us they were happy working in the home and they had received the training they needed to meet diverse needs of the people who lived there.

The staff at the home worked in co-operation with others. We saw that each person's care had been reviewed annually and that relevant health care and social care professionals had been involved in this process.

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

The equipment provided at the home promoted peoples comfort, safety and independence. It was safe to use and had been well maintained.