Archived: Apple Blossom Lodge

We spoke with all the people who used the service. Due their disabilities, people living in the home had limited verbal communication. However, we observed staff working with them and we participated in playing games with some people who lived there. We spoke with three staff, the manager and the provider. We looked at various documents and files, including all care plans and three staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

We found that the provider had suitable monitoring in place to ensure that the premises were maintained to a good standard and so providing the people who lived there a safe environment to live in.

We found that staff recruitment was robust to check that staff were suitable to work with vulnerable adults. Staff also received regular training to ensure they were equipped with appropriate skills and knowledge to do the work they were employed for.

People who lived in the home were unable to discuss with us if they felt safe. We spent time observing staff interactions, people living there appeared relaxed and calm in the company of staff.

Is the service effective?

We saw from care records that other care professionals, for example doctors, opticians, district nurses and dietetic services were involved with the health and welfare of people living in the home.

We spoke with staff who demonstrated a good knowledge of individuals' needs.

Is the service caring?

We observed staff and saw that they spoke with people with compassion and good humour. The atmosphere in the home was very relaxed and people were supported at their own pace.

We saw that people expressed their preferences in what to eat and drink, where they wished to sit and which activities they wished to be involved with.

People living in the home were comfortable and calm in the company of staff. People actively looked for staff companionship and support to play games and engage with.

Is the service responsive?

We saw from care records that appropriate professional support was obtained when necessary to support individuals to stay healthy and well.

Is the service well-led?

Staff had a good understanding of the values expected by the provider and manager.

There were auditing processes in place to ensure that people received appropriate care and that staff were supported and supervised.

Quality assurance systems have been established to monitor and ensure the quality within the service. This will need to continue to be developed..

You can see our judgements on the front page of this report.

At this inspection we found staff had received refresher training about the Mental Capacity Act 2005 and safeguarding vulnerable adults. We spoke with three members of staff who were aware about the issues of consent and safeguarding.

Guidelines were now in place to help staff when people became distressed and there were some updated risk assessments. However we still identified concerns regarding the delivery of care.

At this inspection we found that maintenance requirements were up to date and the home had implemented cleaning schedules.

We had previously identified concerns with recruitment processes and at this inspection found the process was still being revised and that there were stil concerns. We identified at our last visit that there was only one member of staff on duty in the home at night. At this inspection we were assured there were now enough members of staff to meet people's needs at the home.

We also identified some issues with poor record keeping .

The purpose of this inspection was to check whether the provider and manager had addressed the concerns identified in the warning notice.

We spoke with four relatives of people who lived at the home who told us they were happy with the quality of care provided. One person told us that their relative 'loves it there and is very settled' and another said 'We are happy with the home.'

We spoke with the manager and two members of staff who told us about the improvements that had been made. We found improvements in the monitoring of the quality of service, such as the use of surveys to gain people's views and improvements in the complaints procedures. We also found improvements in the systems in place to manage risks, such as the recording and monitoring of any incidents.

We will continue to monitor the home to ensure that improvements are built on and sustained.

We found staff did not understand the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DOLS) and the issues of consent. We were told after our inspection that training was being organised for all staff.

One relative said her relative 'seemed happy at the home.' However, we found care plans lacked specific guidance for staff on how to look after people.

We found inappropriate identification and recording of incidents and accidents and we also found safeguarding issues were not reported to us or the local authority.

We found cleanliness of the home was poor and have reported our findings to environmental health. We could not access one room on the top floor which had items stored next to it. We contacted the fire safety authority to check this was safe.

The registered manager told us staffing levels had been reduced to one non senior member of staff at night. We were told the home had an 'on call' system as a means of cover. However this means in the case of an emergency help may not be provided quickly. The senior operations manager told us after our visit that staffing had been increased.

We spoke with two relatives and they were very happy with the standard of care provided. One relative said 'I am very pleased with my daughter's progress.' The local authority had carried out a care review of every person who lived at the home during the summer of 2012. The relatives we spoke with told us they were part of this care review.

We found that there was an adequate number of staff during the day and night to support the people who lived at the home.

At our previous visit we had concerns that people with mobility problems were using steep stairs to access the basement of the home. At this visit we were told that the basement was still being used occasionally but access was by using the ramp to the outside of the building. There were no risk assessments in place to make sure people were safe to use the basement. We also asked for certificates for gas and electrical safety which could not be produced at our visit.