SeeAbility - Applewood Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People lived safely and were protected from avoidable harm. Staff and leaders were able to identify situations that amounted to safeguarding and staff were confident to use the whistleblowing process if needed. Risks were managed well. Some risk assessment reviews were overdue but this was being addressed by the managers and there was no risk to people. Staff knew people well and were able to identify changes in behaviours and presentation that meant that people were feeling anxious, upset or concerned about something. Risk assessments provided detail of triggers and steps to take to support people when required. Lessons were learned when things went wrong, an example of this was the overhaul of the process for administering and recording medicines. Medicines were administered and recorded safely and in line with service policies. Staff were recruited safely and were supported through a robust induction process and with ongoing supervision and appraisal meetings. There were enough staff to support people safely. Ongoing training made sure that staff had the skills needed to support people.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We observed several interactions between staff and people during our visit. We saw safe practice whilst allowing people to maintain their routines and come and go around the service as they wanted. Some people entered the office and were not restricted in any way from doing so. They were supported by staff and were allowed to pick things up and move around safely. One person was supported with their money, they placed cash on a table and staff quickly moved this to a safe place, advising the person they had done so.

People were safe and were protected from harm. A person told us, “I feel safe.” Staff were attentive to people’s needs and made sure they were safe as they carried out their daily routines and activities. Some people lived with one to one support. Staff were present to ensure safety but were not intrusive or interfering in what people wanted to do or where they wanted to spend their time. Relatives confirmed that they knew their loved ones were safe. Comments from relatives included, "I know he feels safe there. He had an incident at a previous home before here and I know he feels safe as is also with some people he went to school with” and “He likes it there, he’s happy, that’s the most important thing. If he wasn’t happy or I felt unsure, I’d move him." People and relatives told us they were confident to raise any concerns and knew that they would be responded to.

Staff had received safeguarding training and had yearly refreshers. Staff were able to tell us situations that amounted to a safeguarding concern and the steps they would take. A staff member said, “I have just done safeguarding training and I would report any suspected abuse to the senior and the manager, it would definitely be dealt with. I would report it the local authority. There is a company whistleblowing policy in place.” Staff were similarly aware of whistleblowing and were confident to speak up if needed. A staff member said, “Depends on the issue. If a colleague I’d speak to them and the manager. If it was a manager I know I can whistleblow. Also involve CQC, safeguarding team, local authority and police if needed.”

Safeguarding and whistleblowing policies were in place and were accessible to staff. A safeguarding flow chart was on the wall in the staff office, clear and accessible to all. A member of staff said, “Safeguarding guidance on the wall in office. Would seek advice from local authority if needed.” We looked at safeguarding case files, each had clear timelines and appropriate referrals and contacts made appropriately. Managers had established positive working relationships with the local authority and other statutory partners and were confident to seek advice and report safeguarding issues in a timely way. Relatives and loved ones told us they were kept up to date with any issues, concerns or safeguarding matters that occurred. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service worked within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

We observed safe interactions between staff and people. People moved around the service safely and were supported to spend time where they chose. We were shown the kitchen area where people had a rota to help prepare food for themselves and others. A person did not like using knives and alternative processes were used. People were nevertheless encouraged to use kitchen equipment, under supervision form staff to ensure there were no accidents involving sharps or heat/burns.

People and their loved ones told us that staff managed risks well and they felt safe and protected. Most people responded saying “Very good” in response to a recent internal questionnaire, that the service made them and the people they lived with feel safe. A relative told us, when discussing risk, “They do manage them”; “He does not respond well to changes in routine but there is nothing they (staff) can’t do and they understand his needs.” Relatives also told us that staff picked up on changes to their loved one’s behaviours and presentation and knew people well. Relatives said they had opportunities to discuss with staff at annual review meetings, or more frequently if needed, any concerns or new risks, a relative said, “When stressed he stops eating so there is a balance. We have yearly reviews and I can raise things whenever I need. I will be discussing this when we meet.”

Bespoke risk assessments were in place for people however some had not been reviewed for over 2 years. The manager was aware of this and was in the process of updating the review process. There was no evidence of any harm to people as staff knew people well. Risk assessments had different sections that described all of the information that staff would need to support people. For example there were sections for: ‘behaviours of concern’, ‘general support strategies’, ‘triggers’, ‘early warning signs’ and ‘after event strategies.’ The latter described how best to provide reassurance to people experiencing specific risks for example, give space and time, offer drinks if appropriate and talk to people to establish how they wanted to be supported. For people who were not able to express themselves verbally, communication charts were in place. These clearly described behaviours for example, finger bending, which means the person is anxious and the steps recommended that staff take to support the person. People were supported to come and go as they pleased and were supported by staff in the least restrictive way. Positive behaviour support plans were in place and these were being followed by staff.

Staff knew people well and were confident they could identify any changes in peoples presentation that may be of concern. Some people were non-verbal and staff were able to identify body language and physical signs if there were changes to people. A staff member told us, “From what I have seen so far the care plans and risk assessments are comprehensive, I reviewed one person’s yesterday as we were going into the community with the assigned staff member and it gave information on triggers and things to avoid whilst we were out and what to do if things went wrong.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff had been safely recruited. We examined 4 staff files and all of the required checks had been carried out and documents were all in date. In files we saw copies of references, interview notes, photographic identification and Disclosure and Barring Service forms (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Records of completed induction, yearly appraisal and of regular supervision meetings were all on record. An online training matrix showed that all training was up to date and a built in program alerted managers when a staff member’s training refresher was due.

Staff told us about a thorough induction process and training that provided them with the skills they needed to support people safely. Comments included, “I’ve done lots of various training online, including safeguarding. Currently I am shadowing shifts carrying out house related tasks on my own but working with others with service users” and "Training records are online and there is a deadline for mandatory training.” Staff were supported with regular ongoing supervision meetings, “I have supervision every 6-8 weeks and I also do supervision meetings.” There was some dependency on agency staff but the agency provided the same staff members for continuity. A staff member said, “Most of the time there is enough staff, we work as a team, when we have had staffing shortages we have done extra hours and swapped shifts. The agency does help, we use regular agency and the same worker they know the residents well. One agency worker is just in the process of joining the team.”

People and their loved ones told us that staff were kind, there were always enough staff each day and that they had the right training and skills to support people safely. A person told us, “Staff are very nice and kind to me.” A relative added, “I visit often. He has found the management changes a bit unsettling but that is no one’s fault. They always have sufficient staff and I would say they are all well trained.”

We observed there were enough staff on duty to support people safely. Duty rota’s were completed in advance and a few gaps were filled by agency staff. The agency staff used were regular and familiar with the service. The manager told us of a recent recruitment drive which had resulted in new full time staff being successful at interview.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Each person had their own medicine folder. Each contained protocols specific to the person relating to how and when they preferred their medicines to be given. PRN (as and when required) protocols had been recently highlighted by a visiting medicines team as one of the best they had seen. Folders contained a recent photograph of the person and correctly completed medicine administration records (MAR). MAR record entries were signed, dated and counter signed and included a number count of remining medicines. Folders contained a hospital passport, a short summary of key health and social support needs to be used in an emergency, body maps and charts and medicine profiles. The latter ensured that possible side effects of medicines were recorded as well as any conflict with taking with other medicines. Some people took ‘rescue remedies’, homely remedies that helped people experiencing anxiety. People's medicines had been reviewed regularly following STOMP (Stopping over medication of people with a learning disability, autism or both.)

People received their medicines from trained staff. After several medicine errors occurred during a 12 month period managers had reviewed the process and called in expert professionals to help. Improvements had been made to the way medicines were given and recorded. Processes were now in place for 2 medicine givers to work together, checking each other’s work. There was a further daily check by another staff member to ensure compliance with the new processes and to pick up on any refusals or other issues. In addition managers carried out a regular audit of medicines. Comments from staff included, “Following the issues medicines are done in pairs. We’re a small team so sometimes we are called away so it is better to have 2 doing this”; “Systematic checks are done each day and sometimes spot checks” and “Errors are picked up through handovers. If needed, the local authority and/or CQC are informed.” A team leader confirmed, “Issues with medicines involved 2 members of staff who have now moved on.”

People received their medicines safely. Relatives told us that they were confident that their loved ones received the medicines they needed and that staff would respond to unexpected illness’s and make contact with people’s GP if appropriate. A relative told us, “They understand his needs. Another added, “He has rescue remedies for when he visits the dentist etc. I am confident that staff would support him with any medicine he takes or needs.”