Appleton Court

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. This is the first assessment for this newly registered service. This key question has been rated 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.

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager reported any accidents and incidents to the provider to contribute to the oversight of the service. These were analysed for themes and trends.

Formal processes were in place for the reporting, recording and investigation into learning events, however it was not always clear within the records how the learning had been shared with the team. For example, records showed an incident had been reviewed and recorded the action proposed to ensure learning, however there was no formal action log or sign off to provide clarity as to whether the proposed action had been complete. Staff told us they learnt from when things went wrong and had the opportunity to discuss situations within team meetings to learn from them and improve.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. However, they did not always make sure that continuity of care was to a consistently good standard.

For example, referrals were made to health professionals when required and staff monitored people’s wellbeing and escalated concerns. However, people’s care plans did not always reflect their current care requirements and preferences. One person who had recently joined the service had limited details within the care plan to help instruct staff on their preferences when supporting with personal care. Pre-assessments had been carried out by the local authority social care team; however staff told us that these were not always a true representation of the person and on occasions people will join the service without the correct equipment in place. More work is needed to ensure the admissions process is more robust.

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.

Staff were trained and were knowledgeable on how to identify abuse and how to report this. There was a system in place to help keep people safe and the registered manager knew how to report concerns to the Local Authority if needed.

People were supported appropriately under the Mental Capacity Act (MCA). The service proactively ensured people were not restricted in their daily lives and the support they received reflected this.

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, care records and risk assessments were not always in place where required to evidence effective risk management. We found that some care records did not contain enough information to clearly instruct staff on what care was expected and how to complete this task safely. For example, some people have specific health concerns and equipment but information in the care plan was of minimal detail and did not always include how many staff were needed to use the equipment safely. The registered manager told us that this information was available to people on separate documentation, however we could not be assured staff and agency staff would have access to this. We found that not all identified risks to people had a risk assessment in place, for example people who were identified as at risk of financial abuse did not have a risk assessment in place at the time of the inspection. The provider and registered manager took the feedback on board and worked quickly to improve the records. People had not been affected; however, we could not be assured the service had an effective approach to risk management and their internal governance systems had not been effective in highlighting or addressing these concerns. Due to the concerns relating to governance and records we have followed this up within the well led domain.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager and provider completed regular checks of the environment to help keep people safe. Risks to staff entering people’s homes had been assessed and staff knew how to report any concerns. People and their families told us they felt the service was safe, security measures were in place to help ensure safety, but these were not overly restrictive as people could come and go when they chose.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Recruitment practices were safe and included the necessary checks on staff to ensure they were suitable to work with vulnerable people. Staff were supported by the registered manager and senior team with regular supervisions and trained in all expected areas of care. The registered manager planned the care calls in advance to ensure suitable staffing numbers. People told us there was enough staff and their calls were always provided when expected. One family member said, “Staff call in throughout the day at set times. There have been no problems with timings, no waiting for them to come.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff encouraged and supported people to help keep the service clean. They worked together daily, and people learnt how to keep their environment infection free. One family member told us, “[Relatives’] home is clean. [Relative] helps to do it. It’s all part of independent living.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medication as prescribed by staff who were competent to do so. There was a system in place for the supply and safe disposal of medication. Any medication errors were identified, and appropriate action was taken to ensure the safety of the person concerned.

More work was needed to ensure appropriate protocols were in place for people who required medication on a ‘when required’ basis.