Apollo House

Apollo House is a residential care home providing nursing and personal care to up to 61 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 56 people using the service.

Apollo House accommodates people across four separate floors, each of which has separate adapted facilities.

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

Staff knew what signs to look for to keep people safe from harm or abuse. Some staff were unsure how to follow external safeguarding and whistleblowing reporting procedures. We have made a recommendation about developing staff knowledge of external reporting processes.

The systems and processes for identifying risks to people had improved. Further improvements were required to ensure effective management of environmental risks.

Risk assessments were fully completed, and strategies identified to mitigate risks. Care plans were in place where physical intervention may be required to keep people safe, these would benefit from review to ensure they contain more detailed information about people’s needs. People's healthcare needs were recorded and well managed. Records of care tasks were fully completed.

Unexplained injuries were investigated to establish the cause and to protect people from abuse and records of injuries were kept up to date with follow up information.

Medicine management had improved. People received their medicines as prescribed from trained staff.

Staffing levels were appropriate during the inspection, and people told us there were enough staff to meet their needs safely. Staff had received all of the training required to support the people living at Apollo House.

Staff felt supported within their roles and felt confident to discuss any concerns they may have with the management team.

Feedback was sought from people, relatives and staff to identify where improvements were needed. Staff, people and relatives were also offered regular meetings to share information and discuss any concerns they had.

People were protected against infections such as COVID-19. Staff followed government guidance and wore appropriate personal protective equipment (PPE). The home appeared clean. Cleaning schedules were in place to evidence when cleaning was completed.

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.

Systems to monitor the quality and safety of the service were in place to ensure people received safe and person-centred care. These required time to be embedded in the service to ensure they were sustained and improvements continued.

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 2 June 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This is the second time the service has been rated requires improvement.

Why we inspected

This inspection was carried out to check whether the Warning Notices we previously served in relation to Regulations 12(1), 13(1) and 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The overall rating for the service has not changed following this focussed inspection and remains requires improvement.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. 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 Apollo House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Apollo House is a residential care home providing personal and nursing care to 35 older people at the time of the inspection. The service can support up to 61 people.

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

Unexplained injuries had not always been investigated to establish the cause and to protect people from abuse. Records of injuries were not always kept up to date with follow up information.

Not all risk assessments had been completed or strategies identified to mitigate risks. Care plans did not always contain the information required to ensure staff knew the person’s needs. People’s healthcare needs had not always been recorded and managed.

Records of care tasks had gaps in the recording. We found repositioning charts had not been consistently completed, fluid charts had no recommended amount and had not been tallied up, oral care and continence needs were not consistently recorded, and skin integrity checks had not been completed. These failures put people at risk of harm.

Systems and processes in place to ensure oversight of the service were not effective. Not all information had been audited to ensure it was factual and up to date.

Medicine management required improvement. We found staff had not recorded the reason, time and outcome for administering ‘as required’ medicines as per the provider's policy.

Staffing levels were appropriate during the inspection, however people and staff told us additional staff were needed to complete activities and spend time with people. The service was using high levels of agency staff while they recruited permanent staff into post.

Some staff had not received all of the training required to support the people living at Apollo House. However, people told us most staff were kind and respectful to them.

People were protected against infections. The registered manager completed regular COVID-19 testing on staff and people. Visitors were required to complete a test before entering the service. Staff wore appropriate personal protective equipment (PPE) and received training in infection control.

Staff, people and relatives knew how to complain. Recorded complaints had been responded to within the provider's timeframe.

People were supported to have maximum choice and control of their lives and mental capacity assessments had been completed. Staff supported most people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s communication needs were documented, and the provider understood the accessible information standard.

The provider was committed to continuous learning and improvement. The registered manager listened to feedback and sent an action plan through to identify what actions they would be taking to improve.

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

Rating at last inspection

This service was registered with us on 17 August 2020 and this is the first comprehensive inspection.

This service had an infection prevention and control (IPC) inspection published on 30 November 2020. This inspection was not rated.

Why we inspected

We received concerns in relation to the level of care people received, limited information within care plans and risk assessments and limited oversight. As a result, we undertook a full comprehensive inspection

You can see what action we have asked the provider to take at the end of this full report.

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 have identified breaches in relation to safe care and treatment, investigation into unexplained bruising and oversight 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 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.

We found the following examples of good practice.

¿ The provider had identified a specific area within the service to ensure effective use of cohorting and zoning for people who had tested positive for COVID-19. That meant people had rooms and facilities in a certain area of the home, which reduced the potential for the infection to spread. Staff were appointed to work in designated areas which further reduced the potential for transfer of infections.

¿ Risk assessments and procedures were in place for admitting people in to the building. All people entering the building were temperature tested and completed hand disinfection.

¿ The provider ensured plentiful supplies of personal protective equipment (PPE). This included face masks and aprons and we saw staff used these appropriately. Staff were encouraged to change their PPE regularly. Used PPE was disposed of in foot operated pedal bins situated throughout the home which reduced the potential for transfer of infection. There were designated rooms for to change into their uniforms.

¿ Staff encouraged people to wash their hands frequently throughout the day. Where this was not possible, hand sanitiser was offered as a means to reduce the transfer of infection.

¿ The provider participated in regular COVID-19 testing of people living in the service and staff. That ensured action could be taken swiftly to reduce the potential spread of infection if a positive test was returned.

¿ Areas were cleaned and disinfected with cleaning products approved to reduce the potential transfer of infection. The home was recently deep cleaned by a professional company.

¿ Risk assessments had been completed to protect people and any staff who may be at a higher risk of contracting COVID-19, measures were in place to support them.

¿ Staff worked in set teams with staff working in defined areas, which lessened the potential of cross infection within shift members.

Further information is in the detailed findings below.