Appleby Grange

Updated 15 October 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Appleby Grange is a ‘care home’. 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave less than 24 hours’ notice of this inspection. This meant we were able to work alongside the management team to identify any potential risks associated with the coronavirus pandemic and put measures in place to manage them.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We did not speak with people directly to seek their views on the service, due to the coronavirus pandemic. We observed them to be comfortable and enjoying staff company. We contacted six relatives by telephone. During the visit we spoke with the registered manager, operations director, a housekeeping staff and a cook. We contacted eight staff by telephone for their views.

We reviewed a range of records. This included two people’s care records and multiple medicine records. We looked at staff files in relation to recruitment and training. We also reviewed a variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance plans.

Updated 15 October 2020

About the service

Appleby Grange is a care home that provides nursing and personal care for adults. The service can support up to 29 people. At the time of the inspection there were 24 people living at the home.

The home consisted of a large adapted main building and two ground floor flats in the grounds.

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

At the last inspection the provider had not made sure that governance systems were sufficiently effective to monitor and improve the quality and safety of the service. Since then there had been improvements in the way the staff carried out audits to check the safety of the service. The provider was developing corporate governance tools so the home could be monitored against its own expected standards. We have made a recommendation about this.

At the last inspection some staff had not always had training in essential areas. This had improved and staff spoke positively about the training they had received during the pandemic.

At the last inspection there were no records to show how decisions had been taken by others in the best interests of people who lacked capacity. Records were now in place and there were plans to improve these further.

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

The service was safe. Risks to people’s health and safety were assessed and mitigated. Medicines were managed in a safe way. There were enough staff to make sure people received care and support when they needed it.

People’s needs were assessed to make sure their care could be provided by this service. Staff were familiar with how people needed to be supported. Staff worked well with other health services to make sure people’s health care needs were met.

Relatives praised the care that people received. They described staff as knowledgeable and friendly. Relatives and staff said the home was well-run and the registered manager was “very approachable”.

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 requires improvement (published 14 April 2020) and there were three 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.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 2 March 2020. 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 the need for consent, staff training 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, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

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