We undertook this inspection on 15 December 2014 and the inspection was unannounced, which meant the registered provider did not know we would be visiting the service.
The service was last inspected on 6 September 2013 and was meeting all the regulations assessed during the inspection.
The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 15 May 2013. 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.
Applegate House is a community support service providing accommodation and personal care for up to six younger adults with a learning disability and autistic spectrum disorder. There were four people living at the service on the day of our visit. Applegate House consists of six individual self–contained flats each with a bedroom, en-suite bathroom, kitchen/diner and lounge.
Personalised programmes and flexible staffing enabled people to learn to live as independently as possible with the minimum of support. This was based on the philosophy of the organisation ‘fitting a service around you, not fitting you within a service.’
There was a strong person centred culture apparent within the service. (Person centred means care is tailored to meet the needs and aspirations of each individual). Personalised programmes and flexible staffing enabled people to learn how to live as independently as possible with the minimum of support. People told us they felt included in decisions and discussions about their care and treatment. Staff described working together as a team, how they were dedicated in providing person centred care and helping people to achieve their potential. Staff told us the registered manager led by their example and were supportive of them.
People lived in a safe environment. Staff knew how to protect people from abuse and they ensured equipment used in the service was regularly checked and maintained. Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s right to make decisions.
The registered provider had policies and systems in place to manage risks, safeguard vulnerable people from abuse and the safe handling of medicines. Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on best practice guidance and least restrictive practice to support people’s safety. This guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.
CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, when they lacked capacity, these had been made in the person’s best interests.
Recruitment practices were safe and relevant checks had been completed before staff commenced work.
People who used the service spoke positively about the care they received. People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided.
People’s nutritional and dietary needs had been assessed and people were supported to plan, shop for ingredients and to prepare their own meals. People spoke positively about the choice and quality of food available.
People were able to discuss their health needs with staff and had contact with the GP and other health professionals as required. The service made appropriate and timely referrals to healthcare professionals and recommendations were followed. People were supported to attend routine health checks.
There were sufficient staff on duty to meet people’s needs. Staff received training and support to enable them to carry out their tasks in a skilled and confident way. People who used the service were matched with staff who had similar hobbies and interests in order to support them with their preferred activities. These included; furniture restoration, radio, visiting radio stations, theme parks and voluntary and paid work placements.