The inspection took place on 5, 6 and 16 October 2017. The inspection was unannounced. Apple Mews Care Home is based in a residential area of Middlesbrough. The home provides personal care and nursing care for older people and people living with dementia. The service is situated close to the local amenities and transport links. The service is registered for up to 45 people and on the day of our inspection there were 35 people using the service.
At the time of our inspection the service had a registered manager. The registered manager was an area manager rather than the home manager who had direct responsibility for managing the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People were not always supported appropriately with their medicines. We found that medicines were not always administered and managed safely. We found errors that were also not identified by the audits in place and some medicines were not stock checked correctly.
The premises were well presented and clean in most areas. However, we found that carpets on the first floor needed cleaning or replacing and the laundry room needed attention.
People were not always supported by enough staff to meet their needs. We received mixed feedback from relatives and people who used the service regarding staffing levels. The service relied heavily on the use of agency staff and this was impacting on the service people received.
People were supported to make decisions but we found that where best interest decisions were made, these were not recorded appropriately.
We found a quality assurance survey had taken place with stakeholders using questionnaires. There had been little uptake and no action taken to engage more people or to address issues raised in the feedback.
People had care plans in place, however some information in these plans was not recorded correctly including people’s food and fluid records. Audits by the home manager did not always pick up on inaccuracies in care records.
There were effective systems in place for continually monitoring the safety of the premises including maintenance checks and fire safety.
Records showed us there were robust recruitment processes in place.
People took part in planned activities and we observed many activities taking place. Throughout the inspection we saw that people who used the service, relatives and staff were comfortable and had a positive rapport with the staff.
People were supported by caring staff. We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness. We saw staff communicating with people well.
The atmosphere of the service was busy and welcoming. People who used the service and their relatives told us they felt at home and visitors were always welcomed.
Care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care plans showed that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, dentist or optician.
Care plans contained individualised information and were person centred. This meant support needs were planned around the person and took into account their preferences.
Records showed staff were supported and able to maintain and develop their skills through training and development opportunities that were accessible at the service. Staff confirmed they attended a range of valuable learning opportunities. Although some were in need of refreshing, courses were already booked for staff to attend.
Staff were supported by regular one to one supervision meetings with their manager and annual appraisals to discuss and monitor their progress and development.
People were encouraged to eat and drink sufficient amounts to meet their needs. They were offered a varied selection of drinks and snacks. The daily menu was reflective of people’s likes and dislikes. They were offered varied choices and it was not an issue if people wanted something different.
A complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The compliments we looked at were complimentary of the care staff.
People had their rights respected and could access advocacy services if needed.
People who used the service and their representatives attended regular meetings and were asked for their views about the care and service they received but these were not always acted upon.
The home manager held regular team meetings for staff to attend where they could voice opinions and share good practice.
The home manager ensured the CQC were informed of significant events in a timely way by submitting the required notifications.
The service’s fire safety action plan from the local fire authority was in place to address issues and this was effectively managed by the home manager.
We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating the management of medicines, staffing levels, suitability and cleanliness of the premises and accuracy of record keeping. You can see what action we told the provider to take at the back of the full version of the report.