Archived: Applewood House & Apartments

Applewood House and Apartments is a residential care home for people with autism and learning difficulties, providing personal and nursing care. The service can support up to 13 people, ten people in one large house and three people in a connected apartment. There were ten people living at the service at the time of the inspection. The building is one of four services on the Bilsthorpe site owned and run by Lifeways.

The service has been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. However, the service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right support for the following reasons; there was a lack of choice and control; people had not been supported to undertake social activities of their choice on a regular basis; staff did not always support people in the least restrictive way.

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

People living at the service were not always safe, as safeguarding concerns were not effectively reported, monitored or analysed in a timely way. This had resulted in lessons not being learnt following incidents occurring. People and relatives told us they did not think the service was safe.

Risks to people’s safety was assessed but staff did not always follow this guidance.

People were not always supported by enough staff, and staff did not always know people well enough. Staff had not always received up to date training to support people in a suitable way.

There was a lack of evidence to show complaints and concerns were managed. The quality monitoring processes had not been undertaken consistently enough to provide effective oversight of the service.

Peoples medicines, nutritional needs and health care needs were managed. People were protected from the risk of infection. Staff supported people to maintain their privacy and dignity.

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

The last rating for this service was Good (published 8 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, safe guarding issues, lack of activities and management of the service. A decision was made for us to inspect and examine those risks.

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 Applewood Home and Apartments on our website at www.cqc.org.uk.

We have identified breaches in relation to staffing, management of safeguarding issues, safe care, person centred care, and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

People’s experience of using this service:

• Although there were quality monitoring processes in place at the service to improve the care for people. Further improvements in some aspects of the quality monitoring processes were required to sustain improvements made at the service during the last year.

• People felt safe at the service and the risks to their safety were well managed with clear strategies in place to reduce the risks for people.

• People were supported with appropriate numbers of staff. Their medicines, nutritional needs, and health needs were well managed, and they lived in a clean and well maintain environment.

• People were supported by staff who had appropriate training for their roles.

• Staff gained people’s consent before providing care.

• 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. They were supported to express their views and opinions about their care.

• People had formed positive relationships with staff who knew their needs and preferences.

• People’s dignity and privacy was maintained by a staff group who also encouraged people’s independence.

• There was a positive culture at the service and people and their relatives felt listened to, they could raise complaints or concerns and know they would be addressed by staff.

Rating at last inspection: This is the first inspection of this service under this provider.

Why we inspected: This inspection was a planned inspection undertaken to ensure the new provider for the service was meeting the regulations of the Health and Social Care Act and the Care Quality Commission Registration Regulations.