9 January 2019
During a routine inspection
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.