We carried out a review of the data available to us about Appleby Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Appleby Grange, you can give feedback on this service.
Appleby Grange is a care home that provides nursing and personal care for adults. The service can support up to 29 people. At the time of the inspection there were 24 people living at the home.
The home consisted of a large adapted main building and two ground floor flats in the grounds.
People’s experience of using this service and what we found
At the last inspection the provider had not made sure that governance systems were sufficiently effective to monitor and improve the quality and safety of the service. Since then there had been improvements in the way the staff carried out audits to check the safety of the service. The provider was developing corporate governance tools so the home could be monitored against its own expected standards. We have made a recommendation about this.
At the last inspection some staff had not always had training in essential areas. This had improved and staff spoke positively about the training they had received during the pandemic.
At the last inspection there were no records to show how decisions had been taken by others in the best interests of people who lacked capacity. Records were now in place and there were plans to improve these further.
People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.
The service was safe. Risks to people’s health and safety were assessed and mitigated. Medicines were managed in a safe way. There were enough staff to make sure people received care and support when they needed it.
People’s needs were assessed to make sure their care could be provided by this service. Staff were familiar with how people needed to be supported. Staff worked well with other health services to make sure people’s health care needs were met.
Relatives praised the care that people received. They described staff as knowledgeable and friendly. Relatives and staff said the home was well-run and the registered manager was “very approachable”.
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 14 April 2020) and there were three 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 we found improvements had been made and the provider was no longer in breach of regulations.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 2 March 2020. 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 the need for consent, staff training 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, Effective 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 changed from requires improvement to good. This is based on the findings at this inspection.
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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Appleby Grange on our website at www.cqc.org.uk.
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.
Appleby Grange is a care home providing accommodation and personal care for up to 27 people aged 65 and over who require nursing care. Some of the people lived with dementia and required support with their physical needs. At the time of the inspection there were 22 people using the service.
People’s experience of using this service and what we found
People told us they felt safe and protected from abuse and ill treatment.They had received their medicines as prescribed. However, medicines such as topical creams and thickening powders were not always administered by staff who had received training in the safe handling of medicines. There were adequate numbers of staff to meet people’s needs and staff had been safely recruited. People were not adequately protected from risks of infection because not all staff had received training in this area. The registered manager took immediate action to address. Improvements were required to ensure people were adequately monitored following falls that involved head injuries or unwitnessed falls and ensure lessons were learnt from significant incidents. We made a recommendation about this.
People were not always supported by staff who had received the right training to meet their needs. Staff had been supported with induction, supervision and appraisals to prepare them for their roles, however there had been a time when this had not happened as planned. The new registered manager was addressing this. People told us staff sought their preferences, however, people’s ability to make decisions and to consent to care had not been assessed. Staff had not received training in supporting people with decision making. Staff supported people to have access to health professionals and specialist support.
There had been a change in management which had affected the smooth running of the service. The governance and quality checks in the home did not consistently promote the delivery of safe care and treatment. The registered provider had not established good governance in line with best practice and to ensure compliance with regulation. Some policies in the home did not promote the effective delivery of care. The registered manager was in the process of reviewing these. People, their relatives and staff spoke positively about the registered manager. The registered provider had not established robust oversight on the running of the service and compliance with regulations. At the time of the inspection the provider had not implemented their dementia strategy to promote person-centred care. We made a recommendation about person-centred care.
Staff supported people with meaningful day time activities inside the home and in the local community. People's individual communication needs had been assessed and staff had tools to assist their interactions with people. The registered manager dealt with people's concerns and complaints appropriately.
People were positive about the service and said staff were kind and caring. They told us they were treated with dignity and respect and their right to privacy was upheld. However, staff had not received training in areas such as equality and diversity and dementia care to enhance their practice. People were comfortable in the company of staff.
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 (06 September 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement:
We have identified breaches in relation to the staff training and supervision, safe care and treatment, seeking consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
Appleby Grange is a care home with nursing that is registered for 27 people. The service supports people who need nursing care and live with dementia. The building is on one floor and rooms have en-suite facilities. The home has separate lounges and dining rooms. The garden areas are accessible for people in wheelchairs with seating available for people who live at the home. Car parking facilities are available.
This is the first inspection at Appleby Grange following the new providers registration details with the Care Quality Commission (CQC).
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.
The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults. Training records looked at confirmed this.
Medicines, including controlled drugs, were stored in a clean and secure environment. We observed nursing staff followed correct procedures when they administered medication and fully completed records. Control drugs were in use and correct storage and record keeping was in place.
We looked at staff training records and the registered manager’s training matrix and found staff received a wide range of training to support them in their role. Staff informed us access to training was good and one said, “Always supported to further your development by doing training courses and professional qualifications.”
We found recruitment checks were carried out to ensure suitable staff were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members, our observations during the two days visit, looking at staffing rotas and recruitment documentation.
During the inspection visit we observed people having their meals where they chose to. People who lived at the home could have their breakfast at any time and where preferred. This was confirmed by talking with people. Comments were very positive about the meals at Appleby Grange, one person who lived at the home said, “The cook is fantastic she does home baked cakes every day we are so lucky to have her. “
When we discussed the principles of the MCA and DoLS with the registered manager and staff, they demonstrated a good understanding. The registered manager told us they were in the process of completing multiple DoLS applications.
We found people had access to healthcare professionals and their healthcare needs were met.
The management team completed a variety of assessments, which formulated each person’s care plan and nursing needs if required. Records were personalised to individual needs and reviewed on a regular basis.
People who lived at the home and relatives told us staff had a caring, sensitive and kind attitude. Comments included from a relative, “The staff are always friendly, polite and from what I see kind to residents.”
People who lived at Appleby Grange had information on how to raise a complaint or voice any concerns. Relatives we spoke with and people who lived at the home confirmed this. The complaints procedure was available in the reception area of the home so people and visitors had the information at hand.
Staff updated care plans on a regular basis to check support continued to meet people’s changing needs. The registered manager completed life histories of each person and checked their wishes in relation to, how they preferred to be known as, their interests, religious needs and meals.
The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, relative surveys and staff/resident meetings to seek their views about the service that was provided.