The Care Quality Commission
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Archived: Applegarth Care Home

Overall: Requires improvement read more about inspection ratings

24 Huntercombe Lane North, Maidenhead, Berkshire, SL6 0LG (01628) 663287

Provided and run by:
H Surdhar

Important: The provider of this service changed. See new profile

All Inspections

26 September 2017

During a routine inspection

Applegarth Care Home is registered to provide accommodation and personal care for up to 20 older people and people living with dementia. On the day of our visit there were 20 people living in the service.

The service had a registered manager. 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 and associated Regulations about how the service is run. The registered manager was not present during our visit. The proprietor informed us the registered manager had decided not to return back to work after an absence of leave and was working out their notice period. However, a new home manager had recently been employed, who was present throughout our visit. During the registered manager’s leave of absence, the deputy manager took over the responsibility of running the service.

We previously inspected the service on the 6 and 8 July 2015. The service received an overall rating of ‘good’ with ‘requires improvement’ in the key question, is the service well-led. This was because there was not a registered manager in post, which is a legal requirement.

We found the provider did not make sure managerial staff were appropriately supported and obtained further qualifications that would enable them to perform their job role.

Actions in response to medicines audits were not always promptly addressed. We have made a recommendation for the service to seek current guidance on how to respond promptly to findings from medicines audit.

People did not always receive effective care because there were no assessments in place to assess whether people, specifically those who were unable to communicate, were in pain. We have made a recommendation for the service to seek current guidance in relation to pain protocols for people who find it difficult to communicate.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; even though there were policies and systems in place to enable them to do this.

Reviews of care were regularly undertaken by staff however; we saw no records of meetings held with people or their relatives as part of these reviews. We have made a recommendation for the service to seek nationally evidence-based guidance for how to carry out reviews of care.

Initial assessments were carried out but were not available in people’s care records. We have made a recommendation for the service to seek current guidance on how to make sure initial assessments are easily accessible and available in people’s care records. We found the service did not always make sure people had access to information they needed in a way they could understand.

The service did not maintain accurate, complete and up to date records in respect of people who used the service. The provider was not registered with the Information Commissioner’s Office (ICO), as legally required. Quality assurance systems in place were ineffective in identifying when quality and safety was being compromised.

People were protected from abuse and improper treatment because staff knew what action to take when they suspected abuse had happened. Safe recruitment practices were in place. Sufficient staff were employed that made sure people’s care and support needs can be met. People were protected against hazards such as falls, slips and trips and risk management plans were in place when people’s personal safety had been assessed.

A relative felt staff had the knowledge, skills and experience to carry out their job roles. They commented, “They (staff) are very experienced dealing with dementia.”

Staff were appropriately supervised. People were supported to maintain a balanced diet; their nutritional needs were regularly assessed and they had access to health and social care professionals.

Relatives felt staff were caring. Comments included, “I have never once felt any negative attitudes from staff. Staff interacts with her (family member) in an endearing way and they are very respectful.” A written compliment from another relative stated, “Thank you for the fantastic care, kindness and patience.”

People’s privacy and dignity was respected and staff promoted their independence. Staff demonstrated a good knowledge of people’s needs and gave examples of how they supported people with their care. Information relating to people’s personal data and records relating to the management of the service was kept secure.

Care plans were personalised and contained information about people’s likes, dislikes and the people who were important to them. We observed staff carrying out care that was person centred. People's social needs were met. This was because staff were encouraged to interact meaningfully with people and record their interactions. People received consistent, co-ordinated and person-centred care when they moved in between services. There was a system in place to make sure people could make a complaint about their care and treatment.

People and relatives felt the service was well managed. Comments included, “It’s a very nice place here” and “I think they are all approachable. I know everyone by name.” Staff felt that management were friendly and approachable.

People and those important to them had opportunities to feedback their views about the home and quality of the service they received. Complaints and concerns were taken seriously and used as an opportunity to improve the service.

We found breaches of regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of the report.

6 & 8 July 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 28, 29 October and 3 November 2014 at which a breach of legal requirements under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 was found. Compliance actions were made around safe care and treatment, good governance, need for consent, fit and proper persons employed, staffing and person-centred care.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches and submitted an action plan. We undertook a focused inspection on the 6 & 8 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Applegarth Care Home’ on our website at www.cqc.org.uk’

Applegarth Care Home is registered to provide accommodation and personal care for up to 19 older people. On the day of our visit there were 18 people living in the service.

Applegarth Care Home does not have 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.

At our focused inspection on the 6 & 8 July 2015, we found that the provider had made significant improvements and had followed their plan which they had told us would be completed by April 2015. We found most of the legal requirements had been met, however further improvements were required.

Safer recruitment practices were now consistently being carried out. Risks associated with people’s nutrition and dehydration were clearly recorded, updated and reviewed. Medical records were kept updated and secured. Staff received appropriate professional development and support. The service acted in accordance with the Mental Capacity Act 2005 and the requirements of Deprivation of Liberty Safeguards. Care records evidenced reviews of care were regularly undertaken that involved people and those that mattered to them. People and staff spoke positively about management and felt the service was well led. We found most of the quality assurance systems in place were robust however, care plan audits were ineffective in practice and there was no still registered manager in post.

28, 29 October & 3 November 2014

During a routine inspection

Applegarth Care Home is registered to provide accommodation and personal care for up to 19 older people. On the day of our visit there were 18 people living in the service.

This was an unannounced inspection on 28, 29 October 2014 and 3 November 2014. At our previous inspection in December 2013 the provider was meeting the requirements of the law in all the standards.

The service did not have a registered manager in place at the time of this inspection. The registered manager left the service on the 10 October 2014. A new manager had recently been recruited. At the time of our inspection they had not as yet submitted an application to register with the Care Quality Commission. 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 and associated Regulations about how the service is run.

Senior management told us in the summer of 2014 there was a high turnover of staff. This had an impact on the way care records were managed and reviewed during that period. This meant people were placed at risk of receiving unsafe or inappropriate care, treatment and support.

Risk assessments identified risks were not always managed and reviewed. For example one person had been assessed at high risk for pressure sores. There were no records to show how staff were managing and reviewing the identified risk.

Records were not always kept secure and up to date. This was seen in medicine records and cleaning checklists.

Staff did not have effective induction, supervision, appraisal and training.

People were assessed to identify the risks to their nutrition and hydration needs but these identified needs were not always monitored and managed. For example, care records showed one person had lost weight over a three month period. There were no records to show how this was being managed and monitored by the service.

Staff demonstrated good understanding of the Mental Capacity Act 2005 and had attended relevant training. However, care records showed consent was not always obtained in line with the legislation and records of mental capacity assessments undertaken were not located promptly when required. The service did not meet the requirements of the Deprivation of Liberty Safeguards as they had not submitted any applications to the supervisory body. This meant people may have been unlawfully deprived of their freedom.

People were not always treated with dignity and respect. We observed two people’s rooms were used to store additional items that belonged to other people and the service. Management told us they had obtained consent from the people but did not understand that were infringing on people’s personal space. People gave examples of how staff treated them with dignity and respect. We heard various comments such as, “I am assisted with washing and dressing and I cannot fault them in any way they help me and I feel I keep my dignity” and “They make suggestions about what I wear and ensure I look smart at all times.” During the inspection we observed friendly interaction between staff and the people they supported. People moved freely around the home and those who were less mobile received support from staff when it was required. A staff member was heard getting feedback from people in regards to their food preferences. People were actively engaged in the discussion and were given time to express their opinions. People told us staff were compassionate.

People’s individual care needs were not being regularly reviewed. A relative told us, “Mum has a care plan, but it has not been reviewed recently.” This was supported by our review of care records and what staff had told us. For example, one care record showed no review of care was undertaken for a person. One staff member told us care plans were reviewed every month but this had stopped due to staffing issues. This meant the service was not responsive to people’s changing needs.

The service did not promote an open and inclusive culture and quality assurance systems were not robust enough and did not drive improvements in the quality of care being provided. For example, some people told us they were not aware of the recent changes in management. We found there were no systems to log, monitor and review complaints received. Although feedback was sought from staff, external agencies, and people who used the service, there were no analysis of the feedback received and of actions taken in response to the feedback received.

People told us they felt safe in the service and knew what to do if they had concerns. Staff received relevant training and were able to demonstrate they would take appropriate action if alleged or suspected abuse occurred. There were enough staff to provide care and support to people who used the service.

People spoke positively about how the service met their nutritional and hydration needs. We heard comments such as, “The meals are very good”, “Tasty”, “Hot when served”, “Portion sizes are good and you can ask for more if you wish”, “You do have a choice of meal and I usually have fish instead of meats” and “I do have my cultural foods.” An observation of the lunch time period showed staff were aware of people’s food preference and ensured their individual needs were met. People were given choice and the food offered was healthy and well balanced.

People were appropriately supported by staff to gain access to healthcare professionals. The home manager told us the General Practitioner (GP) visited the home weekly or when urgently required. This was supported by one person who commented, “I can see the doctor if I feel I need to do so, but more often or not I do not need to go to the surgery, because we have a GP that visits every Friday.”

People told us staff responded promptly when they required assistance. Most people said they never had to make a complaint. One person who had complained, felt confident that management would take the appropriate action to resolve their concerns. The complaint policy and procedure was clearly displayed in people’s rooms and in the reception area.

We observed staff carrying out the administration of medicines in line with the service’s management of medicines policy. The service was clean and tidied throughout.

The home had adaptations in place to cater to people’s physical needs. For example, handrails and mobility aids to assist people with standing were available in various parts of the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

12 December 2013

During an inspection looking at part of the service

We did not speak with people who use the service during this inspection. This was because our visit to the location was to check that improvements to the premises had been completed which ensured people's safety.

At this inspection we observed a significant investment had been made in the refurbishment and redecoration of the premises. We also found the provider had obtained risk assessments about the premises which ensured people who use the service, relatives and others were protected. The provider, registered manager and staff had achieved a significant change in improving the safety of the premises for people who use the service.

We found the provider had also updated their statement of purpose about the location.

30 August 2013

During a routine inspection

We spoke with two people who use the service and their relatives, all of whom were complimentary about the menus and cooking. One person told us, 'The food is OK, I don't have a complaint. I like the chef; he will prepare anything you ask ' scrambled eggs, omelettes and salads .'

People who use the service provided positive comments to us about the staff. Both of the people we spoke with and their relatives felt there were sufficient staff. One person said, 'I love them. They pop up when I am in trouble with my legs'.

People we spoke with knew how to make a complaint. We spoke with two people who told us they had no complaints. They told us if they had concerns, they would raise them with the manager.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. Whilst maintenance tasks were completed, some risks identified by the home and others were not adequately addressed . For example, the care workers had identified that window restrictors were failing on the first floor. Despite being recorded and reported to the maintenance person, repairs to the windows had not occurred.

4 September 2012

During a routine inspection

We spoke with six people who used the service, two relatives and representatives from two local authorities who purchased services from the home.

People told us that they were always treated with respect. They told us that it was a ''lovely'' place to live. One person said ''if you can't live at home it's the second best place to live''. People told us that they felt very safe in the home. They told us that staff always seemed to know what they were doing. People told us that staff always listened to them and acted on their wishes. They said that they would know how to complain and who to complain to but they had never had any complaints or concerns about the home.

Relatives of people who used the service told us that they were very happy with the quality of care given to their family members. They said that they were confident that their family members were safe in the home. Relatives told us that staff had a good understanding of their family members needs. They said that the home looked into everything, took all concerns however small seriously and never tried to hide anything. They told us that they felt they were always listened to and some of their views were acted on.

The local authorities told us that they had some concerns about policies, record keeping and environmental issues. These were being addressed directly with the home.