Appletree Grange

Updated 6 April 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. 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 team consisted of two inspectors.

Service and service type

Appletree 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

This inspection was unannounced. We visited the service on 12 and 19 January 2022.

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 who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with five people who used the service and three relatives. We spoke with seven staff including the regional director, registered manager, operational trainer, senior care staff, care staff and domestic staff.

After the inspection

We spoke with a further three relatives by telephone and requested some further quality assurance documents, such as audits.

Updated 6 April 2022

About the service

Appletree Grange is a care home providing personal care to up to 32 people. The service provides support to older people some of whom had a dementia. At the time of our inspection there were 30 people using the service. The care home accommodates people across two floors.

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

The home’s policy on visiting was not aligned to government guidance. The home had taken some actions to mitigate potential impacts on people from not following the guidance, but these were not always robustly explored and documented.

People received safe care. There were systems in place to safeguard people from harm and abuse. Risk assessments were in place to support people to be as independent as possible. Staff were aware of their responsibility to keep people safe and were confident that any concerns raised would be acted upon by the management.

Medicines were administered safely, and staff were knowledgeable about people’s needs. Staff undertook training in the safe management of medicines and regularly had their competencies assessed to ensure they were following the correct practices.

The service followed safe recruitment practices. There were enough staff to meet people’s care needs and there were systems in place to allocate and deploy staff safely.

The service sought and responded to feedback. People told us that day to day issues they raised would be quickly resolved. There were some planned improvements to how staff feedback was gathered and responded to.

Quality assurance systems were in place to monitor the quality of care and support people received. When people had accidents or incidents these were recorded, and actions taken to minimise the risk of reoccurrence.

Management had clear oversight of the service. The registered manager and other staff we spoke with had detailed knowledge about the service. The service had processes for continuous learning and improvements and linked with partner agencies to deliver joined up care.

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

Rating at last inspection

The last rating for this service was good (published 10 April 2021).

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting. A decision was made for us to inspect and examine those risks.

We inspected and found there were some further concerns about visiting, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for this service has remained good.

We found no evidence during this inspection that people were at risk of harm from this concern. We have found evidence, however, that the provider needs to make improvements. Please see the well-led sections of this full report.

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

We will continue to monitor information we receive about the service, which will help inform when we next inspect.