Appletree House is a residential ‘care home’ registered to provide personal care for up to 15 older people in one adapted building. At the time of the inspection there were 15 people living in the care home. Some people were living with dementia or frailty and other associated health conditions.
People’s experience of using this service and what we found
There was a failure to assess, monitor and mitigate risks relating to the health, safety and welfare of people. People's care plans and risk assessments lacked important detail to guide staff on how to make people safe. There were unsafe practices in the way medicines were stored and recorded.
Leadership and governance of the service were not effective in identifying some service shortfalls. There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete.
Some infection control practices did not mitigate the risk of contracting and spreading COVID-19 within the care home. Processes were not in place to support safe visiting inside and away from the care home. Infection control processes had failed to identify some risk of cross contamination and transmission of COVID-19.
Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staffing levels were enough to meet people’s individual needs. Positive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful. People and their relatives told us they were happy with the service they received.
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 30 April 2019) and there were two breaches 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 and the provider was still in breach of regulations.
The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
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 carried out an unannounced comprehensive inspection of this service on 4 March 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to gaining people’s consent and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Appletree House Residential Care Home on our website at www.cqc.org.uk.
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 have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment , infection control and good governance.
Please see the action we have told the provider to take at the end of this report.
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.