Archived: Apthorp Care Centre

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.

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

People were at risk because medicines were not always managed safely and in accordance with best practice guidelines.

Aspects of the building were unsafe and extensive work was required to update the heating and water systems to reduce the risks associated with legionella.

Inconsistencies were found with the quality of record keeping which included care plans and risk assessments.

We observed there to be enough staff deployed to ensure people’s care needs were met. However, we found instances where occupied communal areas were left unattended.

People told us they felt comfortable and safe living in the home. The registered manager and staff

understood their responsibilities to raise concerns and report incidents or allegations of abuse.

People and staff spoke highly of the manager and that the manager was compassionate about ensuring people received high quality care. Staff spoke positively of the home management team, however, there were concerns with staff working relations and conduct which affected staff morale.

We have made a recommendation around ensuring the provider has oversight of whether people have access to activities.

People and relatives told us staff were caring and compassionate and had built good relationships with people and their families.

Staff felt supported and had access to a range of training. People had ongoing access to healthcare professionals.

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.

The provider followed an appropriate recruitment procedure to ensure prospective staff were suitable to work for the service.

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 inadequate (report published 21 January 2019). The service was placed into special measures. We issued an enforcement notice against the then provider (The Fremantle Trust) which removed this location from their portfolio of CQC registered services.

In July 2019, the current provider (Your Choice Barnet) took over the running of the service. This is the first inspection of the service since the service registered under the current provider.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

This was a planned inspection based on the previous rating. Where a service is rated inadequate and placed into special measures, we usually inspect within six months of the report publication date.

In this instance, as a new provider took over the service in July 2019, we made the decision to delay the inspection to allow the incoming provider time to implement improvements. The local authority was closely monitoring the service during this period.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment and premises and equipment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.