Archived: Appleby

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis.

People living in the home and their relatives were supported to maintain contact. When visitors were unable to access the home, for example if they tested positive for COVID-19 technology such as online updates was utilised.

A programme of regular COVID-19 testing for both people in the home, staff, and visitors to the home had been implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and any visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE, and we observed staff wearing it correctly during our inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

Daily cleaning schedules were implemented by housekeepers and increased enhanced cleaning had been put in place by the service including regular daily touch point cleaning.

Appleby is a care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. One floor specialises in providing care and support for men who may display distressed behaviour. The service is registered to support up to 55 people. The regional manager confirmed that they would be submitting an application to reduce the number of people supported to 50 due to refurbishments within the building.

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

Lessons had been learnt since the last inspection and widespread improvements were evident. Medicines were administered safely and regular medicine reviews were held. People told us they felt safe and staff were aware how to raise any concerns. Risks had been assessed and steps taken to minimise occurrence and impact. Safe recruitment practices were followed and there were enough staff to meet people’s needs.

People’s needs, and preferences were assessed and documented in care plans which were regularly reviewed and updated. People’s healthcare needs were met, including an assessment of nutrition and hydration needs. Specialist advice was sought and followed when needed. Staff were well supported and said they attended relevant training which supported them to meet people’s needs.

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

Staff had time to develop meaningful and trusting relationships with people, their families and visitors. Staff were responsive to people’s needs, recognising when people needed support which was provided in a timely manner and respected people’s privacy and dignity.

People, and family members, were involved in planning care and support. People and visitors were happy with the care they received and said they were included in decision making. Staff worked with other professionals and family members to provide people with compassionate care at the end of their lives. People and family members knew how to raise concerns and complaints.

The registered manager had left Appleby in July 2019. An acting manager was in post who was committed to ensuring people received good quality care. The manager had developed an inclusive culture which promoted openness and continuous learning. Following our inspection, the manager applied to become registered with CQC.

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 (22 September 2018) and there were two 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Appleby is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Appleby is registered to accommodate 55 people in one adapted building across two floors. At the time of the inspection we were informed that refurbishments had taken place and Appleby could now only accommodate 50 people. We had not been notified of this change in registration. At the time of the inspection 42 people were resident. The first floor specialises in providing care to men living with a dementia who may, at times, be anxious and distressed.

The service had a registered manager who had been in post on a full-time basis since February 2018. They were registered with the Commission on 7 August 2018. 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 2008 and associated Regulations about how the service is run.

During this inspection we found breaches of regulation in relation to consent and good governance. Mental capacity assessments and best interest decisions had been completed however some were over a year old and had not been reviewed. For some people who lacked capacity their safety was maintained through the use of restrictive equipment such as bed rails and wheelchair lap belts but there was no recorded capacity assessment or best interest decision.

The quality assurance processes had not been sufficiently embedded to identity all the areas for improvement noted during the inspection.

Some care plans lacked detail whilst others were person centred and thorough. Some risks to people had not been assessed and some risk assessments were over a year old. Reviews of risk assessments lacked detail.

The quality of recording of medicines, in particular as and when required medicines and the application of prescribed creams varied. We did not find any people had come to any harm due to the administration of medicines and by the second day of inspection a fully audit had been completed, improvements made and an action plan implemented to ensure sustainability.

Staff were kind and caring in their approach and we observed genuinely warm relationships between people and staff. People told us they were treated with dignity and respect.

Staff understood safeguarding procedures and were confident to report any concerns.

Accidents, incidents and safeguarding concerns were analysed for trends and lessons learnt. Some practices had been amended in response to this analysis.

Concerns and complaints were logged, investigated and responded to. People and their relatives confirmed they had no reason to complain but were confident any concerns would be addressed.

Staff levels were assessed using a dependency tool and there were sufficient staff to meet people’s needs. Safe recruitment practices were in place.

The registered manager ensured staff were well supported, including the provision of formal supervision meetings and an annual appraisal. Staff new in post had their performance and support reviewed in probation meetings.

Training was provided and staff had the opportunity to develop their skills so they could support the nurses with evaluations and some clinical 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.

People’s nutrition and hydration needs were met and they were supported to access healthcare professionals, such as speech and language therapy and the behaviour team as well as general practitioners.

Quality assurance and governance systems were in place and had identified some areas for improvement. Comments from staff were that the registered manager had made improvements since being in post and the morale of the team had lifted.

You can see what action we told the provider to take at the back of the full version of the report.

Following our inspection in October 2014, the provider sent us an action plan to show us how they would address our concerns.

We undertook this full inspection to check that they had followed their plan and to confirm that they now met legal requirements in all areas.

Appleby provides residential and nursing care for up to 55 people, some of whom are living with dementia. At the time of our inspection there were 37 people living at the service.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run.

We found the provider had made positive changes and now met the current regulations in regard to the safe management of medicines. Medicines were stored and administered safely, and people received their medicines as prescribed.

We found people were safe at the service. The building was clean and well maintained, no trip hazards were noted, risks were assessed and staff were trained in safety, emergency and safeguarding procedures.

The service had sufficient staff on duty and they were supported and well trained. Staff recruitment and staff disciplinary processes, as far as possible, protected people from harm.

People received support to ensure they had enough to eat and drink and if they were identified as being at risk of malnutrition or dehydration, suitable monitoring systems were used to maintain their health. Referrals were made to health care professionals in a timely way when required and people were supported with a range of health care services to maintain good health.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.

People were supported by staff that were kind, caring and respectful and knew them well. People were treated with dignity and respect. Staff understood people's needs well and helped them to choice how they went about day to day activities or choosing what they wanted to do.

Complaints had been handled appropriately and in a timely way.

The registered manager and provider had a robust quality assurance system in place and sought feedback from people, their relatives and other visitors to consistently monitor the service provided.

We spoke with a visitor who told us the staff kept them well informed about their relative's condition and they felt good care and support was provided.

We looked at the health and safety records in the home and saw these were regularly updated.

We found that people's personal records, and other records held in the home, were comprehensive, accurate and up to date.

We saw people's needs were assessed and care was planned in line with their needs. Two relatives told us they were pleased with the care provided by the staff. Comments included, "I think they do a good job" and "I have no concerns, the care seems good."

There was sufficient specialist equipment in place to meet people's individual needs and there was a system in place to ensure it was well maintained and fit for purpose.

Staff were well supported and received regular supervision to help them carry out their roles. The staff told us they received good training and the manager and deputy manager were very supportive and approachable.

There was an effective complaints system available and comments and complaints made were responded to appropriately.

We looked at six care records and the majority contained detailed information and were up to date. However we found two people's care records did not contain up to date information about their care needs.

People said they could receive medical and specialist attention when they needed it. We saw there were improvements to the management of skin care and integrity.

We saw people were helped to fulfil their social needs within the home and community. People we spoke with said, "There are things to do, I am getting my make up done", and "We get singers and I like to join in."

We saw, and people told us, their home was clean, free from offensive odours, comfortable and warm. They said, "I have my own room, it is very clean." We saw, and people told us, staff were kind and caring. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was improving.