Applecroft Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the ways people’s medicines were managed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always learn lessons to continually identify and embed good practice. However, they promoted an open and honest culture in relation to complaints and incidents.

The provider had systems in place to ensure any incidents, accidents or complaints were, recorded, investigated and acted upon. Whilst staff took action to mitigate ongoing risk, the management team had not always ensured incident records were fully completed, to include details of any preventative measures put in place. However, the registered manager undertook a monthly analysis to identify any themes and trends, and these were discussed within staff meetings.

The registered manager told us they planned to introduce a regular analysis of any complaints, as well as ensuring more robust recording about any actions taken or learning from these.

The provider had not fully learned lessons from the previous inspections, with repeated issues in relation to the overall governance of the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff worked with other professionals and services to ensure continuity of care when people moved to the service. Staff undertook pre-admission assessments prior to people moving to the service. They obtained information about people’s needs from the commissioners of their care.

The provider’s electronic record system enabled them to generate a hospital pack if needed, which contained crucial information about a person which could be shared in an emergency.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the service. The provider ensured staff were trained to safeguard people and staff knew how to report concerns should they need to. A staff member told us, “I would be straight on the phone to (manager) if there were any allegations of abuse.”

Where required, the registered manager had reported safeguarding concerns under local procedures. However, we found an incident of unexplained bruising which had not been reported. This had been an oversight, and the registered manager addressed this when we brought it to her attention.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Overall, staff assessed potential risks to people, and took actions to mitigate risk, such as providing equipment. Staff considered people’s wishes and choices as part of this planning.

However, some records relating to risk management required additional information to help guide staff. For example, a person seated in a wheelchair had no footrests in place or breaks in use. Staff told us this was due to risks in relation to the person pushing themselves backwards, but there was no risk assessment in place. There was no reference to the person using a wheelchair in their care plan.

The registered manager told us toiletries were not usually stored in people's bedrooms to mitigate any potential risks, especially for those people living with dementia. However, we saw toiletries were stored in some bedrooms. Person-centred risk assessments were not in place in relation to this storage and/or any ingestion risks. The registered manager agreed to ensure individualised assessment were undertaken.

The registered manager had updated some risk assessments and management plans, making these readily accessible for staff to read. They had taken some recent actions to strengthen security checks, following an incident where a person had gone outside unsupervised, which could have presented a risk.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Whilst the provider had systems in place to monitor the safety of the environment, they had not identified and/or addressed some of the issues we found. In one area, equipment and various other items were not stored securely and were accessible to people. Following our feedback, the registered manager undertook a risk assessment and secured the area.

Aspects of the service needed refurbishment. Some carpeting was threadbare and other flooring needed replacing. A new shower had been fitted, but some tiling needed to be replaced. The provider confirmed arrangements had been made to replace some flooring and they had a rolling plan to update and decorate. The lift required a new part, which was on order, however, the lift was safe to use in the meantime.

A maintenance person undertook regular health and safety checks. Certificates and other records demonstrated routine maintenance and safety checks were undertaken. A fire risk assessment had been completed, which highlighted some required actions. The registered manager confirmed these had been completed. Ongoing fire drills and evacuations were in progress and fire training for staff had been arranged.

The provider had fitted some new doors to people’s bedrooms. One person liked to have their bedroom door open, and we saw this was held open using a chair, which meant it would not automatically close in the event of a fire. The registered manager confirmed they would arrange for further work to be undertaken on the new doors in relation to this issue.

Overall, there were sufficient staff to respond to people’s needs. However, some staff shared frustrations about not always feeling able to provide unrushed care to people. On occasions, staff undertook kitchen duties to cover staff absences. Night rotas demonstrated times when there were no permanent staff on duty and regular agency staff were utilised. The registered manager confirmed arrangements were in place to ensure any medication administration was completed safely in these circumstances.

The provider had staffing vacancies and often used agency staff to cover staffing gaps. The management team were trying to recruit staff. They aimed to use regular agency staff, so they got to know people. Feedback indicated the recruitment of staff could not always be prioritised due to workloads.

Staff received induction and regular refresher training. Staff were positive about the training and support they received. Systems were in place to ensure agency staff had undertaken appropriate training. However following a recent incident, a gap in agency staff knowledge was highlighted, as they were unfamiliar with aspects of the electronic recording system. The registered manager took some immediate actions to address this issue.

The registered manager ensured staff were supported through regular supervision and appraisal meetings. The provider had safe recruitment procedures in place.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Overall, the environment was clean and domestic staff followed cleaning schedules. Staff undertook training in relation to infection prevention and control (IPC) and had access to PPE.

The registered manager acknowledged they had not undertaken any recent routine audits relating to IPC or staff use of PPE. They did make some observations in relation to this as part of a regular walkaround of the service.

There was an outside area used to store large bins including a clinical waste bin. The clinical waste bin was unsecured, allowing unrestricted public access to hazardous waste. We raised this with the registered manager, who locked it and reminded staff about the procedures in place.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We identified several issues where staff had not appropriately followed the provider’s medicines policy and procedures. Whilst the provider completed medicines audits, these were not effective, as they had not identified all the issues found during our assessment.

Staff did not always administer peoples’ medicines at the right time or in line with instructions. Examples related to time critical medicines or medicines which should not be given with other medicines. Records relating to antibiotic medication demonstrated staff had not always administered these at appropriate intervals, in line with best practice.

Whilst the provider had processes to ensure controlled drugs were managed and stored safely, in one case, staff had not recognised a medicine as a controlled drug and had therefore not stored it in line with regulations.

Staff used bowel monitoring records to help determine whether ‘As required’ (PRN) laxative medication was needed. However, they used both paper and electronic records, and for one person these records differed. This meant PRN medication may potentially be given when not required.

Where protocols were in place to guide staff about when to administer PRN medicines, these did not always provide sufficient detail. For example, where medicines were prescribed for “Agitation”, there was no further guidance for staff, such as signs, triggers, alternative support and when this should be administered.

Staff recorded opening dates on topical products such as creams. However, some were still available for use once they were passed their suggested expiry dates. The registered manager agreed to audit all creams/ointments to ensure they were still in date. Whilst senior care staff had completed medication training, other care staff who applied prescribed topical products during people’s personal care, had not received medicines training or been assessed as competent to do this.

We identified further gaps in practice, and the registered manager took some immediate actions in response and told us they would seek further support to strengthen their oversight systems and processes.