Archived: Apple Hill

We found an effective system was implemented to identify, assess and manage risks at the location. Improvements were made to ensure people were safe and that there was effective and well-led care. Regular monitoring of the quality of the service was in place, which included gaining people's feedback and acting on it.

The provider had notified us, without delay, of relevant incidents via statutory notifications which occurred whilst services were provided.

We found the registered person had not reported applicable incidents to us without delay, as required by the regulation. This meant we could not effectively monitor the safety and quality of services provided to people.

We were provided with a printed copy of a staff training audit completed on 20 September 2013 which included safeguarding topics. The provider told us would be doing another audit at the end of October 2013, to identify any updates for staff training that needed to be booked. There was a system in place to ensure that staff received regular training in safeguarding people who use the service.

Since our last inspection significant improvements were achieved by the provider in relation to requirements related to workers. This was due to the employment of a new administrator to the registered manager who had primary responsibility for arranging new staff interviews, checking documentation, assembling personnel files and auditing current employee files.

We found the provider still needed to improve their systems for monitoring medication refrigerator temperatures, screening people at risk of malnutrition and ensuring agency workers had information related to their employment on shifts at the location.

At lunch time, we saw some people who required support by staff with their meal. We observed staff who were helping people were delivering this care in a calm atmosphere and in a patient manner.

We spoke with 11 people who use the service. They told us they felt safe living at Apple Hill. However, at the time of the inspection, 22 staff had not received training by the provider regarding safeguarding. Many of these staff were workers who provided direct care to people, such as support workers or nurses.

We spoke with five members of staff who had all commenced working at the location within the previous seven months. All of the workers told us about the recruitment procedures they had undertaken. We looked at the recruitment documentation for eight workers. We saw that for all eight files, documents and some checks required by the regulation were missing from all of the files.

Regular audits of the quality and safety of service provision had been completed. However, the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We saw the provider now had a comprehensive quality assurance system in place since our last visit. Regular audits including care plans, medication, health and safety and infection control were completed and the manager told us that these fed into the ongoing improvement plan.

People we spoke with were aware of the complaints system operated by the provider. One person told us they had raised a complaint and another person we spoke with told us they knew how to raise a complaint but had never raised concerns. Other people we spoke with provided feedback related to the care home but the feedback did not relate to the provider's complaints system.

We observed the records storage in four units of the care home. We observed people's care documentation were now kept securely and could be located promptly by staff when needed

At a previous inspection on 2 October 2012 and 12 October 2012, we found the provider was non-compliant with four outcomes, and we took enforcement action against the provider.

At our last visit to the home, we observed use of language and terminology which implied the service was operating as a hospital rather than as a care home. During this inspection, we observed references to hospital terminology had been removed by the provider and staff we spoke with referred to the service as a care home.

We saw that culturally appropriate food was now being offered to people who use the service that preferred this. A new chef had been employed by the provider, the menus had been redesigned and we saw alternate diets were available for people who chose to have them.

Since our last inspection, the provider changed their method of assessing, managing, recording and investigating safeguarding matters. The provider had worked closely with the local authority and us to ensure people were safeguarded against abuse.

We found improvements were made by the provider to the management of people's medicines.

People told us that in the main they felt safe at Apple Hill and relatives told us that they thought that people had their basic care needs met by the service. One relative commented on individual members of staff who she said were 'lovely' and 'great'. However, we were told by three people living at Apple Hill that night staff 'send you to bed' and one person said 'staff take away your liberty'. People also told us about some of the restrictions placed upon them for example, not being able to go out when they chose to.

We found that people's care and treatment was not always delivered in accordance with their care plans. Care plans and risk assessments did not always take into account people's rights and did not always comply with the Mental Capacity Act 2005.

People told us they did not feel able to complain.