Background to this inspection
Updated
26 March 2021
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 Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. 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
This inspection was carried out by two inspectors, a medicines inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. They supported the inspection by making phone calls to relatives to request feedback.
Service and service type
Apthorp Care Centre 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 announced. We gave a short period notice of the inspection due to restrictions in place during the COVID pandemic.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, including notifications submitted, action plan, service improvement plan and communication with the local authority. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all this information to plan our inspection.
During the inspection
We spoke with ten members of staff including the Head of Care, registered manager, senior care workers and care workers. We spent time observing the experience of people in the home and the way staff interacted with them.
We reviewed a range of records. This included five people’s care records and eight people’s medicines records. We looked at two staff files in relation to recruitment. A variety of documents relating to the management of the service, including policies and procedures, complaints and incident records were also reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke to seven relatives by phone. We looked at training data and quality assurance records. We requested feedback from one professional who regularly worked with the service.
Updated
26 March 2021
About the service
Apthorp Care Centre is a care home providing personal and nursing care to 32 older people at the time of this inspection. The service can support up to 82 people in one adapted building, separated into eight self-contained flats. Not all flats were being used at the time of the inspection, due to low occupancy at the service.
People’s experience of using this service and what we found
We observed people to be cared for by staff who were caring and compassionate. Relatives spoke positively of the caring and friendly staff team.
People were not always receiving their medicines safely and as prescribed. Systems and processes in place to manage medicines safely were ineffective. This was identified at a previous inspection.
There remained ongoing concerns with the overall safety of the building. There had been delays to the replacement of windows. Following extensive remedial work to the home’s water and heating system, improvements were seen to the levels of Legionella detected at the service, however it had not been fully eradicated. There were risk management plans in place to reduce the risk this posed to people using the service.
There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, additional cleaning and safe visiting precautions. We saw staff consistently not wearing Personal Protective Equipment (PPE) appropriately. The management team promptly addressed this concern through additional spot-checks and training.
Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. We found that a significant proportion of staff had not received training in first aid. Following the inspection, the registered manager confirmed that this training had been booked for staff who did not already have it.
Quality assurance audits had failed to identify improvements needed at the service in relation to medicines and infection control and training concerns that we identified on this inspection. The service’s improvement plan was not kept up to date.
Relatives praised the service for keeping their loved ones safe during the COVID-19 pandemic, however some relatives felt communication and updates could be improved. We have made a recommendation about this.
There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.
People living at Apthorp Care Centre had a care plan which detailed their needs and preferences. Staff knew people’s care needs well. People were supported to engage in activities, although these were impacted by the pandemic.
Staff spoke very positively of the registered manager and we heard how staff morale had improved at Apthorp Care Centre. Despite the challenges posed by the COVID-19 pandemic, the registered manager had implemented some improvements and new processes at the service.
The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and care professionals.
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 (published 28 November 2019) and there were breaches of regulation in relation to medicines management and premises and equipment.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
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 coronavirus and other infection outbreaks effectively.
We carried out an unannounced comprehensive inspection of this service on 15 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and premises and equipment.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apthorp Care Centre on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to medicines management, premises and equipment and good governance at this inspection.
In response to the breach identified regarding good governance, regulation 17, we will be writing to the provider asking them to provide an action plan to cover the issues identified and to provide time specific updates on the progress of actions taken to address the concerns found on this inspection.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.