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Archived: Appledale Cottage Residential Home Good

Reports


Inspection carried out on 12 January 2016

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 12 January 2016, 25 and 26 February 2016 and 17 March 2016.

The home is registered to provide accommodation and personal care for adults who require nursing care and who may have a dementia related illness. The home is jointly owned and one owner is also the registered manager. A maximum of ten people can live at the home. There were seven people living at home on the days of the inspection. There was a registered manager in place. 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 last inspection on 1 June 2015 we asked the provider to take action to make improvements in how people consented to their care and how the provider records reflected the care people received to ensure that it met their needs. The provider wrote to us to say what they would do to meet legal requirements and this action had been taken.

People felt safe in the home and relatives told us that they felt assured their family members were supported in a safe way with staff that helped to keep them safe. Staff told us about how they kept people safe from the risk of potential abuse. During our inspection staff were available for people and were able to support them by offering guidance or care that reduced their risks. People told us they received their medicines as prescribed and at the correct time. They also felt that if they needed extra pain relief or other medicines these were provided. People told us there were enough staff to support them when they needed or wanted help or assistance.

People told us staff knew what care they needed and relatives felt assured the staff were trained in how to look after the needs of people who lived at the home. All staff we spoke with felt supported by the manager and were able to discuss their role or training needs.

People told us they enjoyed the food and that it was well prepared and always available. Where needed people they were supported to eat or had their meal prepared in an alternative way such as softer options. People had not always been involved in the planning of their care due to their capacity to make decisions. However, relatives felt they were involved in the care of their family member and were asked for their opinions and input. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

Staff developed positive, respectful relationships with people and were kind and caring in their approach. People told us and we saw that their privacy and dignity were respected and staff were kind to them. People received supported to have their choices and decisions respected and staff were considerate of promoting their privacy and dignity. Staff anticipated people’s care needs and attended to people in a gentle and unhurried way.

People told us they had chosen to maintain their hobbies and interests and we saw people were happily knitting, reading or listening to music. Staff offered encouragement and supported people to go out on trips with friends and local community groups.

People and relatives we spoke with told us they would happily raise any complaints with the registered manager. However they had not needed to follow or use the provider’s complaints policy as they were happy with their care.

Management and staff had implemented recent improvements to record keeping which showed how they made changes to people’s care or medicines. These would need to be regularly reviewed to ensure people’s care and support needs continued to be met. People and relatives felt they were involved the home and that it suited them well. The registered manager regularly checked th

Inspection carried out on 1 June 2015

During a routine inspection

This inspection took place on 1 June 2015 and was unannounced.

Appledale Cottage Residential Care provides accommodation and personal care for older people and people living with dementia for a maximum of 10. On the day of our inspection nine people were living in the home.

The home had a registered manager in post who was also the provider. They were not present for our inspection. 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.

People told us that they felt safe living in the home. However, not all the staff were aware of how to protect people from potential harm. The provider did not understand how to protect and uphold people’s human rights. Where decisions had been made on people’s behalf it was not recorded why this had been done and why they were in their best interests.

People told us that they did not have to wait a long time for staff to support them and there were enough staff on duty to care for them. People were supported by staff to take their prescribed medicines and we saw that medicines were stored and recorded appropriately.

People were supported by staff who had not received regular training to ensure they had the skills to care for them properly. People told us that they were happy with the meals provided but they did not have a choice of meals. People told us that they had access to other healthcare professionals when needed.

People told us that staff treated them well but they were not involved in planning their care. We saw that people’s right to privacy and dignity was respected.

People were not involved in the assessment of their needs or supported to pursue their hobbies and interests and they did not have access to facilities within their local community. Not everyone was confident to share their concerns with the provider and the complaints procedure did not tell them who or how to share their concerns.

The service lacked effective leadership and the manager was unaware of their responsibilities of ensuring people received a safe and effective service and there were no systems in place to drive improvements.

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

Inspection carried out on 9 July 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

During the inspection we spoke with four people who used the service, four relatives, two care staff and the registered manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We spoke with four people who used the service who confirmed their satisfaction with the care and support they had received. Each person we spoke with confirmed that they felt safe within their home.

One care record provided staff with information about how to assist a person with their mobility. However, discussions with the registered manager confirmed that the person’s care needs had changed. We spoke with two care staff who were unaware of how to support the person with their mobility. This meant that the individual may not receive adequate care and support. The person this care record related to did not have the capacity due to their health condition to tell us about the support they received.

People were provided with support to take their prescribed medicines. Medication administration records (MAR) showed that people had received their medicines consistently as directed by the prescriber. This meant that people could be confident that they would receive their prescribed treatment. However, we found the recording systems for the safe management of controlled drugs were not entirely robust. The registered manager said that action would be taken to address this.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

The people we spoke with told us that staff did ask for their consent before they were provided with support. The registered manager said that all the people who lived at the home had some level of capacity although in some cases this was very limited to consent to care and treatment. Mental capacity assessments had not been carried out. The registered manager said that this was not necessary as no restrictions were required to assist people with their care and support needs. Where necessary a best interest meeting would be carried out to ensure the person received the appropriate support.

We looked at three care records and found that it was difficult to determine whether people had access to other healthcare services. Discussions with the registered manager confirmed that people did not have regular access to these services. This meant that people did not have access to routine health screening.

Is the service caring?

One person told us, “The staff look after you well.” We saw that staff were attentive to people’s needs. We heard one person ask for assistance and this was provided promptly.

One care record contained a body map that showed the person had developed a red area on their skin. We did not see any evidence of action taken to address this. The registered manager was unaware whether the person had received any treatment but confirmed that the person’s skin was intact. This meant that the person may not have received the appropriate treatment to promote healthy skin.

Assessments were in place to identify whether a person was at risk of developing pressure sores. Where a risk was identified there was no evidence of preventative measures taken to reduce the risk. Records showed that one person was at risk of developing a pressure sore. However, the staff we spoke with were unaware of what pressure care the person had received. This meant that people may not receive the appropriate care to ensure their skin integrity.

Is the service responsive?

The people we spoke with said they had never complained about the care and treatment. However, they confirmed that if they had any concerns they would share this with the staff or the manager. One person told us, “The manager is very approachable.”

One care record showed that a person had swallowing difficulties and was at risk of choking and required a liquidised diet. Discussions with the registered manager confirmed that this person had not been referred to a speech and language therapist (SALT) to ensure that the consistency of meals provided were suitable. This meant that the person did not have adequate support and remained at risk.

Is the service well-led?

The registered manager told us that regular meetings were carried out with people who lived at the home and this was confirmed by the people we spoke with. Access to these meetings gave people the opportunity to have a say in the way the home was run.

The registered manager said that quality assurance questionnaires were routinely given to people. One person who lived at the home confirmed that they had completed these questionnaires. This gave people the opportunity to tell the provider about their experiences of using the service.

We saw that a record of accidents had been maintained but the registered manager confirmed that these were not audited to find out if there were any trends. This meant that action had not been taken to reduce further risk to people.

Inspection carried out on 23 April 2013

During a routine inspection

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “The staff are very nice” and another said, “The staff are excellent”.

Inspection carried out on 17 May 2012

During a routine inspection

We visited this home on 17 May 2012.

When we talked to some of the people who were living in the home they told us that they regularly talked with the proprietors as they were often working in the home providing care to the nine people who lived in the home.

During the morning of the visit all of the people who lived in the home gathered in the conservatory. They told us that they did this most days.

We saw that one of the proprietors spent a lot of time chatting with people. The people who lived in the home told us that this was usual. They also told us that this atmosphere made it easy for them to talk to the proprietors about their concerns.

We asked people about the meals that the home provided for them. They said that they enjoyed them. They also said that they often talked about what food they liked and disliked with the proprietors.

People told us that they regularly had visits from family and friends. They said that they were always made to feel welcome.

Throughout the visit we saw that people were treated with respect and their privacy was maintained.

We asked what they thought of their care and they replied with comments like “Very nice here” and “They are very good with us”.

We saw that people were encouraged to take part in activities that they enjoyed. We observed people knitting, reading, listening to music and watching the birdlife in the garden.

People told us that they feel safe living in this home. One of the people said “No complaints; very good with us here”.

Reports under our old system of regulation (including those from before CQC was created)