Appletree Grange

Appletree Grange is a care home providing personal care to up to 32 people. The service provides support to older people some of whom had a dementia. At the time of our inspection there were 30 people using the service. The care home accommodates people across two floors.

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

The home’s policy on visiting was not aligned to government guidance. The home had taken some actions to mitigate potential impacts on people from not following the guidance, but these were not always robustly explored and documented.

People received safe care. There were systems in place to safeguard people from harm and abuse. Risk assessments were in place to support people to be as independent as possible. Staff were aware of their responsibility to keep people safe and were confident that any concerns raised would be acted upon by the management.

Medicines were administered safely, and staff were knowledgeable about people’s needs. Staff undertook training in the safe management of medicines and regularly had their competencies assessed to ensure they were following the correct practices.

The service followed safe recruitment practices. There were enough staff to meet people’s care needs and there were systems in place to allocate and deploy staff safely.

The service sought and responded to feedback. People told us that day to day issues they raised would be quickly resolved. There were some planned improvements to how staff feedback was gathered and responded to.

Quality assurance systems were in place to monitor the quality of care and support people received. When people had accidents or incidents these were recorded, and actions taken to minimise the risk of reoccurrence.

Management had clear oversight of the service. The registered manager and other staff we spoke with had detailed knowledge about the service. The service had processes for continuous learning and improvements and linked with partner agencies to deliver joined up care.

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 good (published 10 April 2021).

Why we inspected

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting. A decision was made for us to inspect and examine those risks.

We inspected and found there were some further concerns about visiting, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for this service has remained good.

We found no evidence during this inspection that people were at risk of harm from this concern. We have found evidence, however, that the provider needs to make improvements. Please see the well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Appletree Grange on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

The home had sufficient supplies of appropriate PPE which was stored hygienically and kept safe and staff were provided with separate areas to put on and take off and dispose of PPE safely.

Staff were careful to maintain social distancing and wore appropriate PPE in line with current government guidance.

Staff demonstrated a good knowledge of how to support people that had tested positive or were showing symptoms of COVID-19.

The senior staff explained the quality systems they had in place to check the service was providing safe care.

All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Further information is in the detailed findings below.

Apple tree Grange is a residential care home providing accommodation and personal care to 30 older people at the time of the inspection. The service can support up to 32 people.

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

We received positive feedback from people, who told us they were happy living at Apple Tree Grange. They told us they felt safe, enjoyed the food and the level of care and support available. Relatives were happy with the care and support their relatives were receiving.

People received person-centred support and staff knew people well. The care plans in place covered all aspects of peoples care and support preferences to ensure a personal and individualised experience. People were supported to maintain important personal relationships with partners, peers, friends and relatives.

There were systems in place for communicating with staff, people and their relatives to ensure they were informed. People had links to the local community through regular access to the neighbouring community centre.

People were supported to have their say and to exercise their rights and access to advocacy was available if required. Information could be made available for people in the correct format. 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 leadership in the service ensured this practice was the norm.

Healthcare professionals recommended the home and spoke positively of the registered manager and staff team and were included in people’s care and support as and when needed. People who need specialist diets were supported.

The environment was clean and homely, and maintained to a good standard with personalised bedrooms. Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required. There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.

Medicines were managed well, safely administered and recorded accurately. Individualised risk assessments were in place. Staff were confident they would raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

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 good (4 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Appletree Grange is a 32 bed care home that provides personal care to older people and people with a dementia related condition. Nursing care is not provided. There were 32 people living there at time of 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 2008 and associated Regulations about how the service is run.

The home was warm, clean and had comfortable communal areas inside and outside. People, relatives and staff told us the bedrooms and internal communal areas were small. There were sufficient numbers of staff, with the required skills to meet the needs of the people living there.

People or their relatives told us they felt safe, and were being cared for by staff who knew them as individuals. Staff told us they knew how to raise concerns and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Appletree Grange and the home was always welcoming and had a homely atmosphere.

Risks to people, such as from malnutrition and skin integrity issues, were assessed and care plans were in place to protect people from harm. Where people’s needs changed, referrals were made for health care services and any advice from professionals was integrated into people’s care plans.

Staff were trained and managed so that they could work flexibly with different people and were deployed so that at peak times there was sufficient staffing in place. Staff were flexible throughout the day to meet the needs of people, for example ensuring support for people at mealtimes.

People’s medicines were managed safely; stock control and ordering were managed by trained staff with checks of staff competency to ensure that the risk of errors were minimised. Audits were carried out regularly to ensure that any errors would be quickly identified.

Care was effective and people received care based on best practice and the advice of external professionals. Care plans were detailed and personalised. People’s consent to receive care was sought, where this was possible. Where people could not consent, their care was delivered in their best interests after consultation with relevant people and professionals.

There were a number of people subject to Deprivation of Liberty Safeguards (DoLS) and these had been managed well by the service with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals were requested promptly.

Staff were recruited robustly and received training based on the needs of people using the service including dementia awareness. Staff had undergone an induction period and their mandatory training was up to date.

People were supported to eat and drink and maintain a healthy diet. Staff supported people at mealtimes in a dignified way. The service monitored people’s weights and took further action if needed. Visiting health care professionals told us the care and support offered was effective.

Care interactions observed were positive and there were good relationships between people and staff. All the staff we spoke with knew people’s needs well and spoke about them in a positive way. People and their families were encouraged to express their views and to be involved in making decisions about their care and support. There was evidence of people’s involvement in their pre-admission assessments and reviews of care, as well as through meetings and feedback surveys.

People’s choices and rights were respected. Staff knocked on doors before entering, offered people choices and responded to promptly to their requests. People were encouraged to be part of their community and continue relationships and activities that were important to them.

Where people had complained or raised queries about the service, the registered manager responded positively and people were satisfied with the outcomes. Compliments were recorded and any feedback given to individual staff.

Throughout our visit we observed staff and people responded to each other in a positive way. People were engaged in some activity with support and staff spent time with people as they were carrying out their duties.

The registered manager had taken steps to ensure the service was run effectively. There were routine and daily meetings between teams within the home and sharing of information. Regular quality audits were conducted and action was taken where incidents occurred or improvements could be made.

Appletree Grange is a 32 bed care home that provides personal care to older people and people with dementia. Nursing care is not provided. 32 people were living there at time of 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 2008 and associated Regulations about how the service is run.

The home was warm, clean and had comfortable communal areas, the bedrooms and communal areas were small. There were sufficient staff, with different skills to meet the needs of the people living there.

One family told us they felt the service had not kept their relative safe as staff failed to intervene when required. We found that staff had lacked the confidence and competency to support the person and that the normal procedures had not been followed by staff. Action had been taken by the provider following this incident.

Other people or their relatives told us they felt safe, and were being cared for by staff who knew them well. Staff told us they knew how to raise concerns and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Appletree Grange and the home was welcoming and had a happy atmosphere.

Risks to people, such as malnutrition and skin integrity, were assessed and care plans were in place to protect people from harm. Where people’s needs changed, referrals were made for health care services and any advice from professionals was integrated quickly into the care plans and acted upon.

Staff were trained so that they could work flexibly with different people and were deployed so that at peak times there was sufficient staffing. Staff were effectively deployed throughout the day to meet the needs of people. For example ensuring support for people at mealtimes.

People’s medicines were managed safely; stock control and ordering were managed by trained staff with checks to ensure that the risk of errors were minimised. Audits were carried out regularly to ensure that staff were competent and that any errors would be quickly identified.

Care was effective and people received care based on best practice and the advice of external professionals. Care plans were detailed and personalised. People’s consent to receive care was sought, where this was possible. Where people could not consent, their care was delivered in their best interests after consultation with family and professionals.

There were a number of people subject to Deprivation of Liberty Safeguards (DoLS) and these had been managed well by the service with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals were requested promptly.

Staff were recruited robustly and received training based on the needs of people using the service including dementia awareness. Staff had undergone an induction period and their mandatory training was up to date.

People were supported to eat and drink and maintain a balanced diet. Staff supported people at mealtimes in a dignified way. The service monitored people’s weights and took further action if needed. Visiting health care professionals told us the care and support offered was effective.

Care interactions observed were positive and there were good relationships between people and staff. All the staff we spoke with knew people’s needs well and spoke about them in a positive manner. People and their families were encouraged to express their views and were encouraged to be involved in making decisions about their care and support. There was evidence of people’s involvement in their pre-admission assessments and reviews of care, as well as through meetings and feedback surveys.

People’s choices and rights were respected. Staff knocked on doors before entering, offered people choices and responded to requests. People were encouraged to be part of their community and continue relationships and activities that were important to them.

Where people had complained or raised queries about the service, the registered manager responded positively and people were satisfied with the outcomes. Some relatives felt the service still hadn’t responded fully to their complaint after a period of time. The provider’s senior manager undertook to resolve this.

Throughout our visit we observed staff and people responded to each other in a positive way. People were engaged in some activity with support and staff took time to talk to people as they were carrying out their duties.

The registered manager had taken steps to ensure the service was run effectively. There were routine and daily meetings between teams within the home and sharing of information. Regular quality audits were conducted and action was taken where incidents occurred or improvements could be made.

We found that care was planned to meet individuals assessed needs and manage risks to their personal safety. But arrangements for medication were not robust enough to ensure people were always given their medication safely.

A range of checks were carried out when new staff were recruited to make sure they were suitable to work with vulnerable people.

There was an appropriate procedure for making complaints. People and their visitors spoke highly of the service and told us they had no concerns.

We visited the home late evening and saw that there was three care staff, including a senior care worker, on night duty. Each of the staff we spoke with told us this was the usual number, and staff rotas confirmed there had been no reduction. Cover for absences was also organised to prevent any shortfalls to the staffing levels. We found there were appropriate arrangements to ensure there was enough staff to meet the needs of people living at the home.

All reasonable steps were taken to prevent people living in the home from being harmed. Staff were trained to safeguard vulnerable people and knew how to report any suspected abuse or poor care practice. People said they felt secure living in the home and we saw that risks to their personal safety were identified and managed.

Since our last inspection improved staffing levels had been maintained to make sure people's needs were met, and all staff were being provided with regular supervision and appraisal of their work.

We found that people's views, and those of their representatives, were taken into account to monitor and improve the quality of the service. People spoke positively about the care and support they received and told us they were satisfied with the service. Their comments included: 'The home came recommended and has lived up to its' reputation' and 'My mother receives a good standard of care'.