Apple Tree House Residential Care Home Limited

People’s experience of using this service: We received very positive views from people about the support provided to them. People said they felt safe and staff were kind and respectful. People were supported with their communication needs. Staff demonstrated effective skills in British sign language. People told us they felt they were able to communicate their needs to staff.

One event had not been notified to CQC in a timely manner. This is being looked at outside of the inspection process. The registered manager had not ensured all staff had an appraisal a recorded competency check or that 'when required' medications had a protocol for administration in place. Action was taken during the inspection to address these gaps.

People received their medicines safely and on time and their health was well managed. Staff had positive links with health care professionals which promoted people’s wellbeing.

Care and support was tailored to each person's needs and preferences. People and their relatives were fully involved in developing and updating their planned care. People had been supported to develop and maintain positive relationships with friends and family.

Recruitment checks were carried out to ensure staff were suitable to work in the service. Staff had received appropriate training and support to enable them to carry out their role. They worked with people to overcome challenges and promote their independence. Staff encouraged positive risk taking so people could experience new things and develop. This had led to people feeling fulfilled and living an active life.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and staff told us the registered manager and senior team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service.

Rating at last inspection: Good (Published 13 March 2017)

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

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

On the day of this inspection we found that the registered provider had taken action to improve practices within the service following the inspection in September 2015. We found these improvements were sufficient to meet the requirements of Regulation 12, 13 and 17. This meant the service had met the breaches of regulation

The home is registered to provide accommodation for up to 12 people who have a learning disability. On the day of the inspection there were 12 people living at the home. The home is situated in Beverley, in the East Riding of Yorkshire. It is close to town centre facilities and transport links. The accommodation in the main building is on two floors and people who are accommodated on the first floor are able to use the stairs independently. There are also three bungalows in the grounds and these are for single occupancy. There is one flat that is accessed via external stairs and the person who lives in the flat is able to manage the stairs. The people who live in the flat and the bungalows can choose whether to have their meals and spend time in their own space or in the main building. Other accommodation includes a lounge, a dining room, a kitchen and an additional room that is used by people who live at the home and staff for a variety of activities. There is an enclosed courtyard garden.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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. The manager was registered on 14 September 2015 and they had previously managed other care services.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. This included supporting people to take part in their chosen activities. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

People told us they felt safe living at the home. Relatives also told us they felt their family members were safe living at the home and this view was supported by a health care professional who we received feedback from. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. There were effective systems in place to manage any safeguarding concerns.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Medicines were administered safely, and staff had received appropriate training on the administration of medicines.

Relatives and a health care professional told us that staff were caring and people’s privacy and dignity was respected. We saw very positive interactions between people who lived at the home and staff on the day of the inspection.

People's nutritional needs had been assessed and were known by staff. People had a choice of meals to meet their individual requirements.

We saw that any complaints made to the home had been thoroughly investigated and that people had been provided with details of the investigation and outcome. There were also systems in place to seek feedback from people who lived at the home, relatives, staff and health care professionals about the quality of the service provided.

Staff, relatives and a health care professional told us that the home was well managed. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote the well-being of people who lived at the home.

We found that the manager and staff had taken action in relation to meeting the regulations and that records had been updated.

People had been consulted about the support they received and risk assessments had been completed to help ensure people's safety.

Records were now available of the maintenance work undertaken to help maintain people's safety.

One person told us they were happy in the home. They said they were consulted about their care and knew that repairs to equipment had been completed.

Staff were aware of the recording systems in the home and the checks they were required to undertake to help maintain people's safety.

People who lived in the home told us they were happy living there and they felt that their needs were being met. They told us they liked the food provided and had plenty to do.

We observed interactions between staff and the people who lived in the home and the support offered to people form the staff. We saw that conversations were polite and respectful; reflecting a mutual interest in each other.

Peoples care plans were person centred and offered information to staff to help them support the person to live their lives.

People were provided with a varied diet and told us they liked the food provided. However there remained a lack of nutritional assessments.

Staff recruitment had improved to include the necessary checks and people who lived in the home were now involved in this process.

We saw that there was now a staff training matrix, staff told us and their training certificates confirmed that over recent months they had attended a variety of training. There remained a need to undertake specialist training in the home.

We saw that the quality assurance systems had not been developed since the last inspection and this was confirmed by the manager.It was unclear how the provider ensured that the environment met with the relevant legislation.

We found that staff were able to communicate well with people who used the service. Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations.

The majority of records were up to date but they did not have person centred care plans and the risk assessments were not robust.

We looked at staff files and staff training records as part of our visit and we found that staff training and supervisions were not up to date and that appropriate checks were not carried out by the provider before staff started employment.

We found that improvements were needed to the quality assurance system to ensure the provider identified, assessed and managed risks relating to the health, safety and welfare of people who used the service.

We saw that care planning systems took into account the views and wishes of the people who lived in the home. People's wishes and choices were recorded and staff told us how they respected these.

People were supported by adequate numbers of staff who had received training on the safeguarding of people. However the manager was on call to the home seven days a week and the provider may wish to note that this may impact on their ability to perform their role.

There were monitoring systems in the home to ensure people received the appropriate care although the formal quality assurance system had not been utilised over the last year.