Archived: Applegarth Care Home

Updated 28 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 and 27 September 2017. The inspection team consisted of an inspector and a bank inspector.

Before the inspection we reviewed all the information we held about the service. We looked at notifications the provider was legally required to send us. Notifications are information about certain incidents, events and changes that affect a service or the people using it.

We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at all the information we have collected about the service.

We spoke with a visiting health professional during our visit.

During this inspection we were not able to speak at length with people, due to their dementia. We carried out observations of care practice throughout our visit. We spoke with one person; one relative; one care worker; two senior care workers; activity co-ordinator; deputy manager; home manager; operations manager and the proprietor. We looked at three care records; three staff records; seven medicine administration records and records relating to management of the service.

Updated 28 November 2017

Applegarth Care Home is registered to provide accommodation and personal care for up to 20 older people and people living with dementia. On the day of our visit there were 20 people living in the service.

The service had a registered manager. 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 and associated Regulations about how the service is run. The registered manager was not present during our visit. The proprietor informed us the registered manager had decided not to return back to work after an absence of leave and was working out their notice period. However, a new home manager had recently been employed, who was present throughout our visit. During the registered manager’s leave of absence, the deputy manager took over the responsibility of running the service.

We previously inspected the service on the 6 and 8 July 2015. The service received an overall rating of ‘good’ with ‘requires improvement’ in the key question, is the service well-led. This was because there was not a registered manager in post, which is a legal requirement.

We found the provider did not make sure managerial staff were appropriately supported and obtained further qualifications that would enable them to perform their job role.

Actions in response to medicines audits were not always promptly addressed. We have made a recommendation for the service to seek current guidance on how to respond promptly to findings from medicines audit.

People did not always receive effective care because there were no assessments in place to assess whether people, specifically those who were unable to communicate, were in pain. We have made a recommendation for the service to seek current guidance in relation to pain protocols for people who find it difficult to communicate.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; even though there were policies and systems in place to enable them to do this.

Reviews of care were regularly undertaken by staff however; we saw no records of meetings held with people or their relatives as part of these reviews. We have made a recommendation for the service to seek nationally evidence-based guidance for how to carry out reviews of care.

Initial assessments were carried out but were not available in people’s care records. We have made a recommendation for the service to seek current guidance on how to make sure initial assessments are easily accessible and available in people’s care records. We found the service did not always make sure people had access to information they needed in a way they could understand.

The service did not maintain accurate, complete and up to date records in respect of people who used the service. The provider was not registered with the Information Commissioner’s Office (ICO), as legally required. Quality assurance systems in place were ineffective in identifying when quality and safety was being compromised.

People were protected from abuse and improper treatment because staff knew what action to take when they suspected abuse had happened. Safe recruitment practices were in place. Sufficient staff were employed that made sure people’s care and support needs can be met. People were protected against hazards such as falls, slips and trips and risk management plans were in place when people’s personal safety had been assessed.

A relative felt staff had the knowledge, skills and experience to carry out their job roles. They commented, “They (staff) are very experienced dealing with dementia.”

Staff were appropriately supervised. People were supported to maintain a balanced diet; their nutritional needs were regularly assessed and they had access to health and social care professionals.

Relatives felt staff were caring. Comments included, “I have never once felt any negative attitudes from staff. Staff interacts with her (family member) in an endearing way and they are very respectful.” A written compliment from another relative stated, “Thank you for the fantastic care, kindness and patience.”

People’s privacy and dignity was respected and staff promoted their independence. Staff demonstrated a good knowledge of people’s needs and gave examples of how they supported people with their care. Information relating to people’s personal data and records relating to the management of the service was kept secure.

Care plans were personalised and contained information about people’s likes, dislikes and the people who were important to them. We observed staff carrying out care that was person centred. People's social needs were met. This was because staff were encouraged to interact meaningfully with people and record their interactions. People received consistent, co-ordinated and person-centred care when they moved in between services. There was a system in place to make sure people could make a complaint about their care and treatment.

People and relatives felt the service was well managed. Comments included, “It’s a very nice place here” and “I think they are all approachable. I know everyone by name.” Staff felt that management were friendly and approachable.

People and those important to them had opportunities to feedback their views about the home and quality of the service they received. Complaints and concerns were taken seriously and used as an opportunity to improve the service.

We found breaches of regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of the report.