Archived: Apple Tree Court

Updated 23 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 09 January 2019. The inspection team consisted of two inspectors 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 service.

The comprehensive inspection was scheduled and as part of the inspection process and we looked at information we already held about the provider. Providers are required to notify the Care Quality Commission about specific events and incidents that occur including serious injuries to people receiving care and any incidents that put people at risk of harm. We refer to these as notifications. We checked if the provider had sent us notifications in order to plan the areas we wanted to focus on during our inspection. We reviewed regular quality reports sent to us by the local authority to see what information they held about the service. These are reports that tell us if the local authority commissioners have concerns about the service they purchase on behalf of people. There were no additional concerns raised. This helped us to plan the inspection.

We used a number of different methods to help us understand the experiences of people who lived at the service. We spoke with seven people, two relatives, six staff members including seniors, care, catering and domestic staff and the registered manager. We also spent time observing the daily life in the home including the care and support being delivered. As there were a number of people living at the service who could not tell us about their experience, we undertook a Short Observational Framework for Inspection (SOFI) observation. (SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.)

We sampled three people’s care records to see how their support was planned and delivered and five medication records to see how their medicines were managed. We looked at two recruitment files to check suitable staff were recruited. The provider’s training records were also looked at to check staff were appropriately trained and supported to deliver care that met people’s individual needs. We also looked at records relating to the management of the service to ensure people received a good quality service.

Updated 23 February 2019

At our last inspection on the 23 November 2016, we found the service was rated as ‘good’ under all the key questions. At this inspection we found there was improvement required under the key questions is the service safe and well led which meant the service is now rated as requires improvement overall.

The unannounced inspection took place on the 09 January 2019. Apple Tree Court provides accommodation and support for up to 26 adults. At the time of our inspection there were 17 people living at the 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.

There was 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 and associated Regulations about how the service is run.

There were insufficient numbers of staff available to meet people's support needs in a timely way. There were occasions when people were left unattended in communal areas. Staff had not observed one person enter another person’s bedroom on at least six occasions because there was no staff available to monitor the corridors. Staff did not have sufficient time to spend with people to engage in meaningful conversation or stimulating activities with some people telling us they were sometimes bored. You can see what action we have told the provider to take at the end of this report.

The home environment required improvement to ensure it was more ‘dementia friendly’ with appropriate signage and decoration to support people to navigate themselves around the home. The use of adapted cutlery, where appropriate, would enable people to eat independently. We have made a recommendation to the provider.

There were gaps in training that had not seen timely refresher sessions or courses being arranged for the affected staff. Some improvement was required to the monitoring of medicines to ensure the provider had appropriate processes in place to make sure people received their prescribed medication.

Staff understood how to protect people from risk of harm. People's risks were assessed, monitored and managed to reduce risk of avoidable harm. People were protected by safe recruitment procedures to ensure suitable staff were recruited. Staff understood their responsibilities in relation to hygiene and infection control.

People told us they received support from staff they felt had the skills required to support them safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were encouraged to eat healthily. People had access to healthcare professionals when needed in order to maintain their health and wellbeing.

Staff encouraged people's independence where practicably possible. People received a service that was caring and respected their privacy. People were supported by staff who knew them well.

People received a service that was responsive to their individual needs. Care plans were personalised and contained details about people's preferences. Processes were in place to respond to any issues or complaints. Where people’s faith was important to them, they were supported to continue with following their beliefs. This included their end of life (EOL) wishes.

The registered manager understood their role and responsibilities and staff felt supported and listened to. People and staff were encouraged to give feedback and their views were acted on to enhance the quality of the service provided to people. People and staff were complimentary about the leadership and management of the home. The provider worked in conjunction with other agencies to provide people with effective care.

Quality assurance systems were in place to identify where improvements could be made. The provider notified us of significant events that occurred within the home.