All inspections: Applegarth Nursing Home

This was a focussed unannounced inspection that took place on the 18th August 2015.

This service was last inspected on the 27th January and 11th February 2015. At this inspection we found that there was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 because appropriate arrangements were not in place to demonstrate that people received all their medicines appropriately.

The above regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the home was no longer in breach of any of the above regulations and met all of the 2014 Regulations.

Following our last inspection we had requested and received an action plan outlining the measures put in place to ensure people received their medicines appropriately and in line with their prescription.

We undertook this focused inspection on the 18th August 2015 to check if the provider had followed their plan and taken action in response to concerns we identified during our comprehensive inspection.

Prior to this inspection visit we had received an anonymous concern regarding the attitude of some support workers towards people they were supporting. During this inspection we observed how staff cared for and interacted with the people living in Applegarth.

We inspected the service against two of the five questions we ask about services: is the service safe and is the service caring. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Applegarth Nursing Home on our website at www.cqc.org.uk.

Applegarth Nursing Home (Applegarth) is a care home with nursing, registered to provide accommodation for up to 53 people with a variety of needs. The home is divided into three units, one providing care for frail elderly people, some of whom may have various forms of dementia and the other two providing care for younger people with highly complex needs. Accommodation throughout the home is provided on two floors with access to the second floor by a passenger lift or stairs. There is some car parking space available for visitors.

The service had a registered manager in post at the time of our inspection visit. 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.

The provider had policies and procedures in place to protect people from harm or the threat of abuse. We observed warm caring interactions between people and the staff who cared for and supported them. This evidenced people were comfortable and relaxed in their surroundings. Staff had completed training in safeguarding vulnerable adults.

We saw that people’s privacy and dignity were preserved at all times.

We saw that care/support plans were detailed and up to date. We saw that risks were identified and risk assessments completed.

Staff had completed training in the protection of vulnerable people and we discussed this with the staff on duty.

We found there was sufficient staff on duty to meet the assessed needs of the people who lived in Applegarth.

We found that medicines were administered correctly and in line with peoples’ prescriptions. Records of medicines administration were correct and up to date.

This announced inspection took place over two days on the 27th January 2015 and the 11th February 2015. During the previous inspection on the 24th and 25th July 2013 we found that the provider met all the standards we inspected.

Applegarth Nursing Home is a care home with nursing, registered to provide accommodation for up to 53 people with a variety of needs. The home is divided into three units, one providing care for frail elderly people, some of whom may have various forms of dementia and the other two providing care for younger people with highly complex needs. Accommodation throughout the home is provided on two floors with access to the second floor by a passenger lift or stairs. There is some car parking space available for visitors.

The service had a registered manager in post at the time of our inspection visit. 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.

People told us they felt safe living in Applegarth. We found staff were aware of their roles and responsibilities to keep people safe at all times. There were procedures to follow if staff had any concerns about the safety of people they supported.

The service worked well with external agencies such as social services and mental health professionals to provide appropriate care to meet people’s physical and emotional needs.

Procedures for the recruitment of staff were robust which ensured only suitable people were employed to care and support vulnerable adults with a variety of needs.

We noted two areas where some improvement was necessary. These were around recording of the administration of creams and topical medicines and the administration of some tablets by crushing them. We were assured by the registered manager this would be dealt with immediately following our inspection visit. When we completed our site visit on the 11th of February 2015 we found that all the records had been brought up to date and the care plans amended accordingly. New procedures had also been introduced to ensure records were continually up to date and checks introduced to ensure sustainability of the record keeping.

We found that staff had access to ongoing training to meet the individual and diverse needs of the people they supported. This ensured staff had the appropriate skills and knowledge to carry out their role effectively.

The service had procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had received training in this subject and were aware of their responsibility under this legislation.

We found that people’s needs were assessed prior to their admission to the home. Records showed people and their family members had been involved in making decisions about what was important to them.

We saw that all the people who lived in Applegarth had an up to date and personalised plan of care and support. These were regularly to ensure support staff had sufficient information to provide an appropriate level of care.

The registered manager had a high profile within the home. There was clear leadership by the registered manager and the management team and all were aware of their responsibilities to keep people safe. There was an appropriate internal quality audit system in place to monitor the level of care provided.

People told us they were happy with the care and support they received and observations during our visit evidenced those with limited verbal communication were happy and relaxed in their surroundings.

People told us, 'I am very happy living here and would not want to live anywhere else'. 'The staff are very good indeed and nothing is too much trouble'.

Visitors comments included, 'It doesn't matter what time I visit the staff are always warm and friendly and offer me a cup of tea or coffee'.

We observed that people's privacy and dignity were upheld and staff sought their views, wherever possible, to influence the care, treatment and support offered. People we spoke to understood the care and treatment choices available to them and said they were involved in making decisions about their care and support.

We found the home to be appropriately staffed for the needs of the people living in the home. The staff team were experienced and well trained with specialist skills in caring for people with complex needs.

We saw that the provider had an effective system in place to identify, assess and manage the quality of the care and the environment. This meant the home was clean, tidy and well maintained and people living in Applegarth received the most appropriate care to meet their needs.

We were unable to speak with some of the people that lived at Applegarth because of communication difficulties. We therefore spent time observing people's behaviour and interactions with staff. We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere. We also observed staff responding sensitively to people and picking up cues from body language when they needed assistance or reassurance. We judged that people were being supported to stay healthy and well by a competent and trained staff and management team.

People in this service were protected from harm and abuse because there were suitable policies and procedures in place. Staff had received training in how to recognise abuse and on how to deal with any concerns.

We saw that the home was clean, tidy and hygienic with no unpleasant lingering odours evident. We also found that there were effective systems for maintaining the buildings and environment to be safe, comfortable and pleasant to meet people's needs. There were also effective monitoring systems for maintaining equipment and also quality assurance and maintenance generally. On our walk around the building we saw that rooms were clean and well maintained and that people were able to personalise them with their own pictures and personal items.

People using this service told us they were very happy with the care and support they received.

"I like it here and the staff are very kind".

"The food is very good and there is always plenty".

"The girls take me to the shops when I want to go".

Visitors were also very positive with their comments.

"I find the care excellent and I visit four days a week".

"The care is very good and I can bring in the children if I want".

Archived: Applegarth Nursing Home

All Inspections

18th August 2015

During an inspection looking at part of the service

27th january 2015 & 11th February 2015

During a routine inspection

24, 25 July 2013

During a routine inspection

5 November 2012

During a routine inspection

16 February 2012

During a routine inspection