Applecroft Residential Care Home

Applecroft Residential Care Home is a residential care home providing personal care to 19 people at the time of the inspection. Care is provided across three floors, with shared communal areas including a lounge and dining area and separate bedrooms.

People’s experience of using this service and what we found

Systems to checks and improve the standards of care were not consistently undertaken to drive improvements within the home. However, people and families told us the home was good and they felt involved in discussions. The registered manager and staff worked closely with other professionals and were responsive to suggestions for improvement. There was an improvement action plan in place and this work was ongoing.

The home had suitable systems in place when recruiting staff and there were sufficient staff to meet people’s needs. Medicines were being securely stored and safely managed and people received the support they needed to take their medicine. There were appropriate systems to check and ensure equipment was maintained and the home was clean. We noted some improvements to manage the laundry were implemented immediately. Accident and incidents were managed, and action was taken to prevent reoccurrences, but we noted some improvements that could be made to the analysis of this so that learning can be shared.

People had choice, and preferences were respected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. People were supported to access health care as needed and advice from health care professionals was implemented and care plans updated.

People and relatives told us staff were kind and caring and we observed positive and compassionate interactions between staff and the people living at the home throughout the day. People were encouraged to remain independent and care plans reflected this. People’s privacy and dignity was maintained.

People received personalised care and support. There was a new activity coordinator and people could choose to engage in a variety of activities. People felt able to raise concerns and make complaints and told us these were addressed. Plans were in place for people who required support at end of life and staff were thoughtful and caring when supporting people and their families in this area.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires improvement (published 10 September 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to Regulation 17 (Good Governance) as the provider did not have good systems for ensuring that checks of the quality of support and safety of the environment were regularly undertaken.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Applecroft Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Applecroft is registered to provide accommodation with personal care for up to 23 people. The accommodation is located over three floors. On the day of our inspection there were 18 people living in the home.

This is the fourth consecutive time the service has been rated requires improvement overall.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions: safe, responsive and well led to at least good. We found that they were in breach of the regulations in relation to good governance.

At this inspection, we found that there had been little improvement in the overall leadership and documentation within the service, however the responsive domain had improved to good, but the service remained requires improvement in safe; well led and overall. We found a continued breach of the regulations in relation to good governance. You can see what action we have taken at the back of this report.

Applecroft has no registered manager in post. The current manager has applied to be the registered manager with the Care Quality Commission (CQC). 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 registered provider did not have effective systems in place to assess and monitor the quality and safety of the service. Some of the issues which were identified as part of this inspection, had not been picked up by provider’s audits. Where shortfalls or actions were agreed, the manager was unable to provide documentation to show what progress or actions had been taken to address these shortfalls.

Staff recruitment was safe, however we saw where concerns had been raised about staff conduct, systems had not been followed to address these concerns.

Staff had completed safeguarding training and safeguarding incidents were appropriately referred to the local safeguarding team. However, we saw where recommendations or actions had been agreed following incidents, these had not always been followed up so learning opportunities on how things may be improved or prevented in the future had been missed.

Medication was being stored and administered safely. Regular medication audits were being conducted, however the issues that we identified during our inspection were not picked up by these audits. The provider had policies in place in relation to medication documentation, which were not being followed and this had not been picked up within the audits.

Staff were aware of risks to people and these were managed safely and advice taken from other professionals when necessary. However, documentation around risks was not always in place or detailed.

There were sufficient staff to meet the needs of the people living in the home and they were recruited safely.

Care plans did reflect people’s life history and their needs. We found that some care plans could be more person centred, which had been identified by the manager. People and their relatives told us that the care they received was responsive to their needs.

People and their relatives felt confident that issues that they raised would be addressed. Complaints were recorded and dealt with in accordance with the provider’s complaints policy.

People and their relatives were positive about the staff working in the home as well as the care that they received whilst living there.

The provider was acting in accordance with the Mental Capacity Act 2005 to ensure that people were receiving the right level of support with their decision making. People were involved in the care plans and had signed their consent to care where able. Where people lacked capacity, appropriate paperwork was in place to ensure that decisions were made in their best interests.

Staff members confirmed they received regular training and supervision and we verified this in the provider’s records.

We saw regular checks on the property were undertaken and the premises were safe without restricting people’s ability to move about freely. We did receive some comments about the home being dated and we were told that the provider had a development plan in place to improve the home environment.

People had access to activities within the home and told us that they were happy with the activities on offer.

Applecroft is a privately owned care home located near to Congleton town centre and close to local shops. It is a three-storey building and people can be accommodated on all floors. Access between floors is via a passenger lift or stairs. There are 22 single bedrooms in the home; 16 of them have en-suite facilities.

The service was last inspected in December 2016 when we found three breaches in the regulations. The provider was in breach of the regulations in relation to consent as the provider was not acting within the principles of the Mental Capacity Act 2005. They were also in breach of the regulations around quality assurance as the systems in place were not robustly identifying shortfalls in the service. Furthermore the registered manager had not submitted the required notifications to CQC.

The home has 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 2008 and associated Regulations about how the service is run. At the time of our inspection there were 18 people living in the home.

We found that overall there had been improvements in the service and systems had been put in place, however we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

We found that whilst there were general risk assessments in place, they were not always detailed and regularly updated. We found that staff were aware of the potential risks and appropriate advice had been sought for people living in the home, however the records were not always reflective of this.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’. However we found where there were changes or additional advice had been sought from other professionals, although staff were aware of and following the advice; the care plans had not always been updated to reflect the changes.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. We saw that whilst the audits had improved since our last inspection, they were not always robust as the discrepancies in care plans that we found and risk assessments that were no longer relevant had not been picked up by the audit process. Whilst we found that the registered manager was open and responsive to issues we raised during the inspection, the processes in place to identify issues on an ongoing basis were not effective.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns and these were being reported to the local authority and the necessary notifications were now being submitted to CQC.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. Everyone we spoke to confirmed that there were enough staff and staff were observed to be carrying out their duties in a timely manner. The home was managed and staffed by a consistent team of care assistants who were well supported.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We saw that applications had been made appropriately and where people were able to consent to their care, this was recorded on the care files.

The home was clean and provided a calm, relaxing atmosphere. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures, window restrictors as well as safety checks on the fire alarm system and emergency lighting.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

People living in the home told us that the standard of care they received was good. Comments included, “The care is brilliant. I can’t say anything more” and “I find it very nice here”. Relatives spoken with praised the staff team for the quality of care provided and the friendliness of the staff. They told us that they were confident that their relatives were safe and well cared for. Regular professional visitors to the home were also complimentary about the care given in the home.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food had improved and they had a wide variety of food choices as well as where they could eat their meal.

Staff members, relatives and people living in the home were positive about how the home was being managed and felt that the manager was supportive and approachable.

Applecroft is a privately owned care home located near to Congleton town centre and close to local shops. It is a three-storey building and people can be accommodated on all floors. Access between floors is via a passenger lift or stairs. There are 22 single bedrooms in the home; 16 of them have en-suite facilities.

The service was last inspected in July 2014 when we found two breaches in the regulations. The provider was in breach of the regulations in relation to consent as the provider was not acting within the principles of the Mental Capacity Act 2005. They were also in breach of the regulations around premises as there were a number of outstanding repairs.

The home has 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 2008 and associated Regulations about how the service is run. At the time of our inspection there were 21 people living in the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach in the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the back of this report.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We saw that whilst applications had been made appropriately, consent to care had not been recorded on any of the care files and the latest guidance for covert medication had not been followed.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns, however we did find one instance where a safeguarding incident had not been reported. The registered manager had not submitted the necessary notifications to CQC where incidents of safeguarding had occurred.

We saw that whilst there was now a system in place for reporting maintenance issues, we found some maintenance issues which were addressed during the course of our inspection.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’, however we found some where little information had been recorded about the person’s history and preferences.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. The areas for improvement that had been picked up by these systems had not been acted upon.

The home was clean and provided a calm, relaxing atmosphere. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. However other checks on the fire doors and emergency escape routes had not been completed regularly.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults. The home was managed and staffed by a consistent team of care assistants who were well supported.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. Everyone we spoke to confirmed that there were enough staff and staff were observed to be carrying out their duties in a timely manner.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively. The registered manager had recently introduced a training matrix in order to keep track of people’s training.

People living in the home told us that the standard of care they received was good. Comments included, “I’m so glad I chose this”, “They are exceptional staff” and “They look after me extremely well”. Relatives spoken with praised the staff team for the quality of care provided and the friendliness of the staff. They told us that they were confident that their relatives were safe and well cared for.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good and they had a wide variety of food choices as well as where they could eat their meal.

Staff members, relatives and people living in the home were positive about how the home was being managed and felt that the manager was supportive and approachable.

We wanted to check that people were given the opportunity to consent to the care and treatment offered to them. One person who used the service told us 'You feel free to express whatever you feel' and 'Sometimes you say you don't like something and the staff remember that and take note'.

We talked with care staff as well as the cook and the manager of the home. They showed us a number of records we wished to see as part of our inspection and also demonstrated the computerised care planning and staff records system. We found that most of the records kept by Applecroft Residential Care Home in relation to care planning, equipment, and staff recruitment were satisfactory.

We checked that the equipment used in the home was satisfactory and was well-maintained. We looked at the systems which the home used to provide information so that the quality of care being provided could be monitored.

We met two relatives who were visiting a person using the service. They told us 'it's small and homely. Anyone could be happy here'.One person told us about activities that were available in the Home such as games and we observed staff interacting with people and playing musical instruments with them. However one person asked to see us on their own and told us that they thought that there was 'not enough choice' and that people using the service were 'treated as patients'. This person felt that the Home should 'help people to make their own decisions' and encourage people to 'use initiative'.

We met with the owner of Applecroft and discussed recent developments in the Home. We interviewed the Assistant Manager who described current arrangements there. It was clear that Applecroft had very recently gone through a period of change but that plans and arrangements had already been put in place in order to sustain the service to the people who live there. We interviewed and spoke to three members of care staff who confirmed that these plans were having a positive effect.

Two people told us they thought the food was 'awful' and both felt it could be better. Three people told us they had been cold on occasions lately, especially at night. We discussed these comments with the manager who agreed to review these issues with the people living at the service and she agreed to review the heating arrangements for everyone at the home to ensure they were kept warm and comfortable at all times.

When we visited Applecroft we had the opportunity to observe the care that was being given to people living at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We noted that everyone was well dressed and well groomed. We saw many examples of good communication and patience by care staff, who interacted with people in a positive manner.