Archived: Applegarth Residential Care Home

Updated 27 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Day one of the inspection visits was conducted by three inspectors. Two inspectors returned to the home to complete a second visit.

Service and service type

Applegarth Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection visits were unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection and sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with seven people about their experience of the care provided. We spoke with nine members of staff including the nominated individual, the registered manager, senior team and team leaders, care and domestic staff and the cook. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We observed the care people received. We reviewed a range of records. This included seven people’s care records and multiple medicines records. We looked at three staff files in relation to recruitment and support and a range of records relating to the management of the service, including audits and checks and policies and procedures.

After the inspection

We contacted five relatives who shared positive feedback about the service. We continued to seek clarification from the registered manager to validate evidence found and actions the provider told us they had taken. We looked at training data, and quality assurance records.

Updated 27 November 2021

About the service:

Applegarth Residential Care Home provides accommodation and personal care for up to 25 older people, including people who live with dementia. At the time of our visit 18 people lived at the home. This included one person on a respite stay and two people were in hospital.

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

The providers governance systems to monitor the quality and safety of the service were inadequate. The providers lack of oversight meant some previously evidenced standards and regulatory compliance had not been maintained. The lack of robust governance systems meant the provider had failed to identify and address issues we found. Opportunities to learn lessons and drive improvement had been missed.

The provider and registered manager had not taken action to mitigate known risks. This placed people at risk of potential harm. Government guidance had not been consistently followed to ensure the prevention and control of infection, during the COVID-19 pandemic. Individual, environmental and risk associated with the management of medicines was not well-managed. Despite, our findings people felt safe and staff understood their responsibilities to keep people safe. Staff were recruited safety and were available to support people when needed.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were supported to maintain important relationships and had access to health and social care professionals when needed.

Staff received an induction and training when they started working at the home. However, staff had not received the training they needed to fully understand and meet people’s specific needs. People received the support needed to maintain their nutritional well-being. A refurbishment programme for the home was planned. People had some opportunities to engage in meaningful activities.

People's right to privacy and dignity was not always considered and upheld. Relatives described staff as caring and kind and people had developed meaningful relationships with staff. Promoting and understanding diversity and inclusion was an area requiring improvement.

People's needs were assessed prior to moving into Applegarth Residential Care Home. However, information gathered was not always used to ensure people’s needs were met. People’s care plans and the completion of daily records required improvement. Despite our findings people and relatives were satisfied with the service provided and spoke highly of the registered manager and staff team. Staff felt supported. The registered manager and staff team worked in partnership with other health and social care professionals to support people to maintain their health and well-being.

The registered manager acknowledged and welcomed our inspection feedback and demonstrated commitment to making service improvements to benefit people.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 7 June 2019) and there was a 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 enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted due to information we received indicating poor infection control practice at the home and concerns we identified following an inspection of the providers other location. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to people’s safety, the safety of the environment and governance of the service.

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

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Special measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.