Apple Blossom Court

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to their community that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Within the areas looked at during this focused inspection; the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The design of people’s accommodation, the use of the building and the delivery of people’s support did not promote people’s dignity, people developing or using their skills, maximising choice and being as independent as possible; or promoting them enjoying their home in an ordinary and everyday manner.

Some people’s needs, choices and preferences did not fit in with or clashed with others when using the communal areas of the home. This had led to some people having negative experiences, being isolated from others or choosing to spend their time in their bedroom.

We made a recommendation regarding the application of the principles of right support, right care, right culture.

When we inspected there were not enough staff available to meet people’s identified support needs and complete necessary tasks.

We made a recommendation regarding the deployment of staff.

The registered manager had responded to the COVID-19 pandemic, the home was clean, and steps had been taken to prevent any spread of infection. However, PPE and other clinical waste were not always being stored appropriately.

We made a recommendation regarding the storage of waste at the home.

Staff were kind and respectful in their approach towards people and were knowledgeable about their day to day preferences. People were comfortable with staff members; one person told us, “The staff are nice”.

A series of checks and audits took place to help ensure people received safe care and support. Medication was stored and administered safely, new staff members had been recruited safely and checks took place on the home’s environment and equipment used.

The home now had a manager who was registered with the CQC. There had been a series of improvements at the home under the registered manager. People’s family members, staff and some health and social care professionals praised their approach.

The registered manager undertook a series of audits to ensure safety and manage risk. There had been some improvements and refurbishments made within the home and outdoor areas.

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 requires improvement (published 31 October 2019). The service remains rated requires improvement. This is the second consecutive inspection were the service has been rated requires improvement.

Why we inspected

We received concerns in relation to the quality and safety of the care and support people received. As a result, we undertook a focused inspection to review the key questions of “Is the service safe?” and “Is the service well-led?”.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remans requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the, safe and well-led sections of this full report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Apple Blossom Court is a residential care home providing personal care to 11 people at the time of the inspection. The service can support up to 17 people.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 17 people, 11 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Overall people’s medicines were managed safely, however we identified that the storage of controlled medicines did not follow best practice.

The home was clean, however we identified that areas needed additional refurbishment. Staff had not regularly or appropriately completed documentation that covered tasks such as cleaning responsibilities and checks for health and safety.

We attempted to contact the provider prior to the inspection being carried out for information regarding the recruitment of the new manager and support that was being provided. However, the provider had not contacted the Commission with the requested information at the time of inspection.

Lessons had been learnt following concerns raised by the local authority regarding recruitment however we identified during the inspection that additional improvements were needed.

People living in the home had a comprehensive support plan and risk assessments in place. However we identified that information that had been logged in people’s daily logs had not been incorporated into their support plans. This meant that staff did not have up to date information available.

During the inspection we observed warm and comfortable relationships between staff and people living in the home. However, we identified a confidentiality issue that was not respectful and did not support the dignity of the people living in the home.

People were able to give their opinions on their care service and a range of communication methods were in place to ensure people continued to have this opportunity.

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.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 requires improvement (published 22 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about recruitment, infection control, staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive, Caring and Well-Led sections of this full report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home 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.

People’s experience of using this service: At the last inspection in November 2017 we had rated the service as Requires improvement. This was in relation to the environment, health and safety checks, lack of staff supervision and lack of induction documentation. At the last inspection we also identified that systems and processes did not operate effectively to enable the service to assess, monitor and improve the quality and safety of the services provided.

During this inspection we found improvements had been made. However, we found improvements were needed to the ‘grab file’ that held emergency information for people and the water temperatures were not being regularly checked. This was brought to the registered managers attention that was actioned immediately.

The home had been decorated and refurbished so that the environment was brighter, cleaner and more welcoming. The health and safety checks on the home was regularly completed by the manager and staff were receiving regular supervision. The manager had implemented regular audits of the service and these were completed monthly. The staff induction was in the process of being improved.

At the last inspection in November 2017, we found the provider to be in breach of Regulation as systems to monitor the quality and safety of the service were not always effective. During this inspection we looked to see if improvements had been made and found that they had. The registered manager and staff had a good understanding of their roles and responsibilities within the

service. Systems were in place to monitor the quality and safety of the service. Any issues identified were addressed to ensure quality of care was maintained.

Feedback received during the two days of inspection was all positive from people using the service, relatives and staff.

Staffing were deployed in suitable numbers and staff had time to spend with people and were not rushed. Medication needs were assessed and medication was only given by staff who were trained to do so. Staff were recruited safely, and incident and accidents were analysed for patterns and trends. Risks to people were assessed safely, care plans were person centred and regularly updated.

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Registering the Right Support gives guidance surrounding the maximum amount of people a home providing support to people with learning disabilities should have. Guidance states this should be six however Apple Blossom Court had been registered since October 2016 to provide a service to 17 people. We saw that the home itself was situated in a residential area and that people with learning disabilities who were using the service were able to live as ordinary a life as any citizen. People were able to make their own decisions about their lives for example what they wanted to do and eat.

Rating at last inspection: Apple Blossom Court was previously rated as Requires Improvement. The report was published 07 February 2018.

Why we inspected: This was a scheduled inspection based on the previous rating of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

The home is registered to provide accommodation and personal care for a maximum of 16 adults with a learning disability. The home is a three storey, detached property located in a residential area of Wallasey, Wirral. It is close to local shops and transport links to all parts of Wirral, Chester and Liverpool. At the time of our visit the service was providing support to 15 people.

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. However, we saw that people with learning disabilities and autism using the service were able to live as ordinary a life as any citizen.

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.

During our inspection, we identified a breach of the Health and Social Care Act 2008 in respect of Regulation 17 good governance. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have effective quality assurance systems such as audits in place and other checks did not operate effectively to ensure people received a safe, effective, caring, responsive and well led service.

Monitoring information was not clear in regards to maintenance, people’s weights and daily checks that were meant to be carried out by the staff.

A formal, fully completed application process and checks in relation to criminal convictions and previous employment had been completed when new staff were employed. However we did not see evidence of any risk assessments being carried out on staff whose DBS checks identified past convictions.

We saw that monthly or weekly checks such as fire alarms, fire extinguishers, emergency lighting and water temperatures had not been regularly completed.

We looked at safety certificates that demonstrated that utilities and services, such as gas, electric had been tested and were safe. Fire evacuation plans had been reviewed and updated. Personal emergency evacuation plans (PEEPS) had been completed for all of the people who lived in the service

Staff said they felt supported and that they could approach the registered manager with any concerns, however there was no evidence of a formal supervision and appraisal process.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed by the home. The registered manager told us about people in the home who lacked capacity and that the appropriate number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority.

People's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary. The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place and training to guide staff in relation to safeguarding adults.

The people living in the home were able to express themselves and were able to choose the way they spent their day and were taken to activities outside the home. Each of the people’s bedrooms had been personalised by them and those who were able to choose who entered their rooms and go in and out of the front door freely.

People had access to nutritious food and drink throughout the day and were given menu choices at each mealtime. These options had been chosen by the people who lived at Apple Blossom Court.

Care records and risk assessments were well-kept and up-to-date. Each person living at the home had a personalised care plan and risk assessment.