Appleby Court Care Home

Appleby Court is a care home providing accommodation, personal and nursing care for up to 60 people; some of whom live with dementia. Accommodation is provided over two floors each of which have separate adapted facilities. At the time of our inspection 19 people were using the service and all were accommodated on the ground floor.

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

Risk assessments and care plans were completed on a new electronic care planning system introduced since the last inspection. Risks to people's health, safety and wellbeing were set out in their care plans along with guidance for staff on how to provide people with safe care. Records used to monitor risk included the required information about people’s needs and how they were to be met.

Safe infection prevention and control (IPC) procedures were followed. The safety, hygiene and cleanliness of the environment, equipment and utilities were monitored through regular checks and audits.

Managers and staff understood their responsibilities in relation to safeguarding people from the risk of abuse. Allegations of abuse were referred to the relevant authorities without delay and safeguarding records were well maintained. People told us they felt safe and family members confirmed this. Records confirmed there had been an increase in the completion of safeguarding training since our last inspection.

Medicines were managed safely stored and administered by staff who had the necessary skills and competence. Medication administration records (MARs) were overall well kept, however handwritten information entered onto some people’s MARs had not been signed by the scriber and checked by a second person to ensure the accuracy of the information recorded in line with best practice. The manager addressed this immediately.

Systems were in place to record and analyse accidents and incidents. Records were well maintained, and the outcome of reviews were shared with staff to ensure learning from incidents took place.

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.

A manager had been appointed to work at the service since our last inspection. They commenced this post in February 2023 and had applied to the Care Quality Commission (CQC) to become the registered manager.

Systems and processes for assessing, monitoring, and improving the quality and safety of the service had improved. Newly implemented checks and audits were completed across the service and areas identified for improvement were actioned. There was improved oversight of the service on behalf of the provider. Monthly meetings were held with managers and the provider’s representative where key areas of the service were discussed and evaluated. Action plans were developed for any areas where audits identified improvements were required.

Records relating to people’s care and the running of the service had improved. They were well maintained and regularly reviewed to make sure they were accurate and up to date. People, staff, and family members were provided with opportunities to feedback about their experiences of the care provided. There was improved partnership working with others including external health and social care professionals.

There were enough suitably skilled and qualified staff on duty to meet people’s needs and keep them safe. No new staff had been recruited since the last inspection; however, policies were in place to ensure staff were recruited safely. Checks were carried out to assess the fitness and suitability of agency staff. Nurses’ personal identification numbers (PINs) were checked monthly to make sure they remained valid.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 14 October 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 8 and 13 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

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

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Appleby Court is a care home providing accommodation, personal and nursing care for up to 60 people; some of whom live with dementia. At the time of our inspection 32 people were using the service.

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

People’s safety continued to be placed at risk. Care records continued to lack information and guidance for staff about the care people needed to minimise the risk of harm. Current government guidance for the use of face masks for staff was not being adhered to. Medicines were not always kept safe and secure and handwritten medication administration records (MARs) were not checked to ensure the accuracy of the information recorded. Robust training records were not maintained so we could not be assured staff had the qualifications, competence and skills to meet people’s needs and keep them safe. Accident and incident records continued to lack information about action taken and lessons learnt to prevent or minimise further occurrences.

There continued to be a lack of effective systems to assess, monitor and improve the quality and safety of the service. Audits and checks carried out at the service were unreliable and ineffective, they failed to identify risk and bring about improvements. There was a lack of provider and management oversight of the quality and safety of the service. There were significant delays in submitting notifications to The Care Quality Commission (CQC) of incidents and events which occurred at the service. People did not always receive person-centred care with good outcomes because their records were not fully completed and kept up to date with their current needs and the care provided to them. There was a lack of partnership working with other health and social care professionals to improve the quality and safety of the service people received.

There was the right amount of suitably qualified staff deployed across the service to meet people’s needs and keep them safe. Recruitment of new staff was safe. People told us they felt safe and were treated well by staff. Family members told us that they were happy with the care their relative received.

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 February 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to people’s safety, governance and leadership. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to people’s safety and the governance and leadership of the service.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Appleby Court is a care home providing accommodation, personal and nursing care for up to 60 people; some of whom live with dementia. At the time of our inspection 32 people were using the service.

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

Risks to people were not always assessed, mitigated or planned for, monitored and reviewed. We found examples where care records were incomplete and lacked information about the care people needed and received to minimise the risk of harm. There was a lack of guidance for staff on how to manage identified risks people faced. Wound assessment and monitoring records were not consistently kept up to date therefore we could not be assured that wounds were safely managed in line with current best practice guidance.

Although incidents and accidents were recorded there was no oversight of the records to look for patterns and trends and whether any lessons could be learnt to prevent or minimise further occurrences.

Some environmental hazards posed a risk to people’s safety. This included an unlocked sluice room, storeroom and some vacant bedrooms which contained potential hazardous items and trip hazards. This was addressed after we raised it with staff.

There was a lack of effective systems to monitor the quality and safety of the service. Audits and checks were not consistently used to assess, monitor and improve the care people received. There was a lack of provider oversight of the quality monitoring systems at the service. There was a failure to identify and mitigate risk and bring about improvements to the service people received.

The provider had not always notified The Care Quality Commission (CQC) of incidents which they are required to do by law.

Some people did not always receive person-centred care with good outcomes because their records were not fully completed and kept up to date with their current needs and the care provided to them.

There was evidence of staff working in partnership with other health and social care professionals, however this was not consistent for all people.

There was the right amount of suitably qualified staff deployed across the service to meet people’s needs and keep them safe. Recruitment of new staff was safe.

We were assured that safe infection prevention and control (IPC) measures were being followed. Government guidance was adhered to ensure safe admissions and visits to the service. The environment was kept clean and hygienic and staff used and disposed of personal protective equipment (PPE) in a safe way.

People told us they felt safe and were treated well by staff. Family members told us that they were confident that their relative was safe and well cared for.

Rating at last inspection

The last rating for this service was good (published 15 March 2019).

You can read the report from our last inspection, by selecting the 'all reports' link for ‘Appleby Court Nursing Home' on our website at www.cqc.org.uk.

Why we inspected

CQC received information of concern about people’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Please see full details in the individual sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 has changed from good to requires improvement. This is based on the findings at this inspection. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to people’s safety and the governance and leadership of the service.

Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice

Procedures were in place and followed to make sure visits both inside the home and within the grounds, took place safely. Visitors entering the service had a lateral flow test (LFT) and were provided with personal protective equipment (PPE). Garden and window visits were also facilitated. Family members confirmed safe procedures were followed when visiting their relatives.

Staff supported people outside of visits to maintain regular contact with family and friends through telephone calls and the use of video calls. A family member told us staff assisted their relative to keep in touch by telephone.

Shielding and social distancing rules were complied with. Furniture in communal areas had been rearranged to help maintain social distancing.

Safe procedures were in place and followed for admitting people to the service. No person was admitted to the service without evidence of a negative polymerase chain reaction (PCR) COVID–19 test and they were supported to isolate for 10 days following their admission into the service.

Staff had completed infection prevention and control (IPC) and PPE training and were provided with regular updates to ensure they were up to date with current guidance. There were good stocks of the right standard of PPE and PPE stations were located across the service. Staff used and disposed of PPE safely. There was a designated IPC lead and they shared good working practices and updates across the staff team.

People and staff had been supported to take part in the COVID-19 vaccination programme and they had access to regular testing.

The environment was clean and hygienic. There was a good stock of cleaning products and equipment, cleaning schedules were in place, which were being followed. There was increased cleaning of high touch areas to reduce the risks of cross infection.

We were assured this service was following safe infection prevention and control measures to keep people safe.

Appleby Court is a care home registered for 60 residents. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Appleby court is ten minutes away from the town of Kirkby. There are fifty-eight single rooms, two double rooms and twenty one rooms providing en-suite facilities. There is communal space on each floor. At the time of our inspection there were 51 people living at the home.

The home had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated good.

The registered provider continued to have safe recruitment processes in place. All staff had completed an induction and undertook training relevant for their roles. Regular refresher update training was also undertaken in accordance with good practice guidelines. Staff received regular and consistent support through supervision and team meetings.

Staff had all undertaken safeguarding training and felt confident about what they would need to do if they had any concerns about the people they supported. The registered provider had safeguarding policies and procedures in place that staff understood where to find.

People had their needs assessed prior to moving into the home and this information was used to create person centred care plans and risk assessments. Documents included clear guidance for staff to follow to fully meet people’s individual needs. People’s needs in relation to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. All care plans were reviewed and updated regularly.

People told us they had developed positive relationships with the staff who supported them. We observed positive interactions between people and staff throughout our inspection. Staff were kind and caring and respected people’s privacy and dignity. A variety of activities were available for people to participate in.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. Medicine administration records (MARs) fully completed and regularly audited for accuracy. Staff who administered medicines had all received training and had their competency assessed.

People’s care plans included information about their food and drink needs. Clear guidance was in place for staff to follow when people required specialist diets or assistance.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken basic training and demonstrated an understanding of this. The registered provider had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

Appleby Court was well maintained and all equipment was regularly serviced. Health and safety checks were regularly and consistently undertaken at the home. Fire safety checks were clearly documented. Improvements were planned at the home to more fully meet the needs of the people living there.

The registered provider undertook regular audits at the home. Areas for development and improvement were identified and addressed. Accidents and incidents were analysed to identify trends and patterns within the home. Fire safety checks, health and safety checks were consistently undertaken at the home.

The registered provider had displayed their ratings from the previous inspection in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Appleby Court Care Home is registered to provide accommodation for persons who require personal and nursing care. The service provides both long term and intermediate care for up to 60 people. Bedrooms are located on the ground and first floor of the building and each floor has two communal lounges, a dining room, bathrooms and toilets. There were 58 people using the service at the time of this inspection.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. 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 last inspection of the service was carried out in May 2014 and we found that the service was meeting all the regulations that were assessed.

We have made a recommendation about the deployment of staff. Staffing levels had been calculated in accordance with people’s needs and the correct number of staff were on duty. However, there were occasions during our inspection when people who were at risk of falls were left unsupervised for long periods of time, therefore putting their safety at risk.

People told us they felt safe and that they had no concerns about how they were treated. Staff understood their responsibilities for keeping people safe and they knew what to do if they had any concerns about people’s health, safety or wellbeing. Staff knew how to respond to medical and non-medical emergencies and they had access to emergency equipment.

People told us they had received their medication at the right times. Medication was stored, administered and disposed of in a safe way by staff who had received appropriate training. Each person had a medication administration record (MAR) which detailed each item of their prescribed medication, instructions for use and the records were completed correctly.

People received the care and support they needed with their healthcare needs. They attended appointments as required with their GP and other health care professionals involved in their care. A multi-disciplinary approach ensured people’s care was appropriately planned for and reviewed.

People told us they liked the food they were offered and that they were given plenty to eat and drink. Staff were knowledgeable about the support people needed with eating and drinking. People’s dietary needs were also met including required food textures, likes and dislikes.

Staff received training and support which they needed. Training relevant to people’s needs was provided to staff on an ongoing basis and their competency was checked to make sure they understood and benefited from the training undertaken. Regular staff meetings and one to one supervision sessions enabled staff to explore their training needs and discuss any additional support they needed.

People were treated with kindness and their privacy, dignity and independence was promoted. Staff recognised when people were upset and they used techniques to calm people, with good outcomes for them. People’s religion was respected and they were supported to practice their faith, this included attending church services both at Appleby Court and in the local community. People at end of life were cared for in a dignified way and their wishes and preferences at end of life were fully respected.

People and family members had been provided with information about how to complain and they were confident that any complaints they raised would be listened to and dealt with.

The service was well managed by a person who was described as approachable and supportive. People, family members and staff said they were not afraid to approach the registered manager or deputy manager about anything. They said there was an open door policy operated at the service which enabled them to speak openly and in confidence to the management team.

Checks were carried out at the service to make sure people were in receipt of safe and effective care. Any shortfalls which were noted during checks were acted upon to ensure improvements were made to the service people received.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found '

Is the service safe?

Staff had received training in topics relating to health and safety and they were confident about dealing with an emergency situation. Risks to people's health, safety and wellbeing had been identified and acted upon to ensure people received safe care and support. Staff knew what their responsibilities were for safeguarding people and people told us they felt safe living at the home. There was the right amount of skilled and experienced staff working at the home to safely meet people's needs. Regular checks were carried out at the home to ensure people were safe.

Is the service effective?

Staff had all the information they needed to meet people's needs and they ensured people received the right care and support. Staff were respectful and polite towards people who used the service and they involved people in their care and the day to day running of the home. People's preferences and choices were understood and respected.

Is the service caring?

People who used the service and their relatives told us that staff were kind, polite and caring towards them. Relatives' comments included, "It is like one big happy family." Staff spent time with people and respected their wishes. People's religious and lifestyle choices were understood and respected.

Is the service responsive?

People were given opportunities to put forward their views and opinions about the home and the way it was run. Any ideas people had for improvement were listened to and acted upon. People's requests for assistance were responded to in a timely way and people told us they had never had to wait too long for staff to help them. People were communicated with in a way they could understand.

Is the service well-led?

People were happy with the care and support they received and they felt able to approach the manager and staff with any concerns they had and were confident that they would be listened to.

We found that people using services at Appleby Court were cared for by staff members who were fit and appropriately qualified for the job. All relevant checks were made by the provider before any employee was allowed to commence work. People were made aware of the complaints system and it was provided in a format that met their needs. If necessary, people were given support by the provider to make a comment or complaint where they needed assistance.

We were able to make general observations within the home during our inspection. We observed staff had a positive rapport with the people who lived there, showing genuine support, warmth and respect.

During our discussions with staff they told us that they were happy within their roles and felt supported by the management and their peers. They told us that training and development was encouraged.

The service had robust quality audit and monitoring systems in place to support the care provided.