Background to this inspection
Updated
12 December 2019
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.
Inspection team
The inspection was carried out by two inspectors and an assistant inspector.
Service and service type
Applewood House and Apartments is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 did not have a manager registered with the Care Quality Commission at the time of the inspection. Both the registered manager 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
This inspection was unannounced.
What we did before the inspection
Prior to the inspection we sought feedback from local authorities, clinical commissioning groups, agencies and healthcare professionals involved with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection-
During the inspection we spoke with three people living at the service, and two relatives, we spoke to nine members of staff, including support workers, agency staff support workers, team leaders, the acting manager, the regional manager, the area manager, and the quality compliance manager. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. We also reviewed all agency staff profile records. We viewed a variety of records relating to the management of the service, including policies and procedures, the training records, audits, accidents and incidents, maintenance, behavioural monitoring records and quality audits.
After the inspection
We continued to seek clarification from the service to validate evidence found.
Updated
12 December 2019
About the service
Applewood House and Apartments is a residential care home for people with autism and learning difficulties, providing personal and nursing care. The service can support up to 13 people, ten people in one large house and three people in a connected apartment. There were ten people living at the service at the time of the inspection. The building is one of four services on the Bilsthorpe site owned and run by Lifeways.
The service has been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. However, the service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people did not fully reflect the principles and values of Registering the Right support for the following reasons; there was a lack of choice and control; people had not been supported to undertake social activities of their choice on a regular basis; staff did not always support people in the least restrictive way.
People’s experience of using this service and what we found
People living at the service were not always safe, as safeguarding concerns were not effectively reported, monitored or analysed in a timely way. This had resulted in lessons not being learnt following incidents occurring. People and relatives told us they did not think the service was safe.
Risks to people’s safety was assessed but staff did not always follow this guidance.
People were not always supported by enough staff, and staff did not always know people well enough. Staff had not always received up to date training to support people in a suitable way.
There was a lack of evidence to show complaints and concerns were managed. The quality monitoring processes had not been undertaken consistently enough to provide effective oversight of the service.
Peoples medicines, nutritional needs and health care needs were managed. People were protected from the risk of infection. Staff supported people to maintain their privacy and dignity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was Good (published 8 March 2019).
Why we inspected
The inspection was prompted in part due to concerns received about staffing, safe guarding issues, lack of activities and management of the service. A decision was made for us to inspect and examine those risks.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Applewood Home and Apartments on our website at www.cqc.org.uk.
We have identified breaches in relation to staffing, management of safeguarding issues, safe care, person centred care, and governance of the service at this inspection.
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.