Archived: Applegarth Residential Care Home

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.

People’s experience of using this service:

• Safeguarding systems were not consistently followed to help minimise risks of people coming to harm.

• Records related to risks associated with people’s health were not consistently clear to show risks were effectively and safely managed.

• People said they received their medicines as needed but some medicine records were not clear to confirm medicines had been appropriately managed.

• Recruitment records were not always detailed to confirm safe processes were followed.

• There were systems to monitor the quality and safety of the service, but they had not been consistent in identifying areas for improvement to be acted upon.

• Staff cared about people and were responsive to their needs. Care plans contained information to support staff in providing personalised care in relation to their healthcare needs.

• People felt safe living at the home and with the staff that supported them.

• Enough staff were on duty during our visit to support people’s needs.

• People’s needs were assessed before they started to use the service to make sure their needs could be met safely and effectively.

• Staff knew people well and respected people’s privacy and dignity.

• People were supported to access healthcare professionals such as GP’s when needed.

• People's nutritional needs were identified and understood by staff but records did not always show people at risk of poor nutrition had consumed what they had been given.

were met. Staff understood people's dietary needs.

• People had access to a range of social activities. Some care records contained information about people’s interests and hobbies to assist staff in supporting people with these.

• People and relatives were happy with the care provided and spoke positively about the leadership of the service.

• The environment was clean, and staff followed good infection control practice.

• People received information in a way they could understand and knew how to raise concerns if they were not happy. Concerns raised had been responded to and acted upon.

• Lessons had been learnt when things had gone wrong.

• The provider encouraged feedback from people, their relatives and staff to help drive forward improvement. Action had been taken in response to the feedback.

• At this inspection we found there continued to be areas needing improvement resulting in a repeated ‘Requires Improvement’ rating.

'Detailed Findings' below.

Rating at last inspection: At our last inspection we rated the service as 'Requires improvement'. The report was published on 1 May 2018.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

Since that inspection we received information about a serious incident which took place at the home. This incident is subject to investigation by the relevant authorities and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk associated with people’s needs and the environment. We undertook a focused inspection to check people were safe. This report only covers our findings in relation to these topics.

This inspection took place on 7 March 2018 and was unannounced.

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

Applegarth Residential Care Home accommodates a maximum of 23 older people in one adapted building across two floors. On the day of our visit 21 people lived at the home. The home is located in Coventry in the West Midlands.

This service 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 home had a registered manager who had been in post since 2016. 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.

Some risks associated with people’s health and well-being and the environment were not always well managed. Records to support risk management in the home lacked detail and were not being accurately completed. Action was being taken to address this.

People received their medicines as prescribed from staff who had been trained in managing medicines safely. However, systems to ensure medicines were administered and managed in line with the provider’s procedure were not always effective and required improvement.

People told us they felt safe living at the home. Staff understood their safeguarding responsibilities and the action they should take if they were concerned a person was at risk of harm.

There were sufficient staff to meet people’s needs. The provider ensured pre-employment checks had been completed before staff started work to make sure, as far as possible; they were safe to work with the people who lived there.

The provider encouraged people and relatives to share their views about the home and how it was run to drive forward improvements. The registered manager used learning from accidents and incidents to make improvements.

Staff enjoyed working at the home and felt supported and valued by the management team.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected in June 2015 where we found improvements were required in the management of the home, risks management and care recording. We also had concerns about the management of medicines, and how people, who lacked capacity to make decisions, were supported. We asked the provider to take the necessary steps to ensure the required improvements were made. At this visit we found improvements had been made in all these areas.

Applegarth Residential Care Home provides care for a maximum of 25 people. At the time of our inspection there were 19 people who lived at the home. Some people stayed at the home on a short term basis when leaving hospital, with the aim of returning back to their own homes.

The service had a registered manager. 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 been in post since February 2016 and registered since June 2016. We refer to them as the manager in the body of the report.

Care plans contained information for staff to help them provide personalised care, were up to date and accurately reflected people’s care needs. People and relatives were involved in reviews of the care provided.

People told us they felt safe living at the home because staff came quickly when they requested assistance, and offered them reassurance when required. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff were effective in identifying risks to people’s safety and in managing these risks.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to reduce the risks of unsuitable staff working at the service. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time.

Staff encouraged people to be independent, and people had gained increasing skills and confidence in their daily lives.

People received medicines from trained staff, and medicines were administered safely.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required. The manager had arranged for the correct assessments if they felt people may be being deprived of their liberty.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided. People were assisted to manage their health needs, with referrals to other health professionals when required.

People had enough to do to keep them occupied and staff tailored activities to people’s individual interests. Staff supported people with one to one social stimulation if this was their preference.

People knew how to complain and could share their views and opinions about the service they received. There were formal opportunities for people to feedback any concerns at meetings and through surveys.

People were positive about the changes in management of the service and the improvements which had made to the environment.

Staff told us they could raise any concerns or issues with the managers, who were approachable and responsive. There were formal opportunities for staff to do this at meetings and one to ones.

There were processes to monitor the quality of the service provided. There were other checks which ensured staff worked in line with policies and procedures. Checks of the environment were completed and staff knew the correct procedures to take in an emergency.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe and we observed a relaxed atmosphere.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We found that people received their medicines as prescribed by the doctor.

There were risk management plans in place for people and health and safety. We noted that the premises were appropriate, well maintained and safe for the people who were using the service.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. When people were admitted to hospital the manager re-assessed them to make sure the home was able to continue to provide their care when they ready to be discharged. There was evidence of people and or their relatives being involved with the development and regular reviews of care plans. Staff encouraged and supported people in leading interesting and enriched lifestyles. The people we spoke with all said they received the standard of care that matched their needs. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

The people we spoke with were positive about the way they were cared for and supported. A person told us: "Staff look after me well." People were cared for by kind and attentive staff. We observed people asking staff to do things for them. Staff responded to the requests promptly and efficiently. The home was supported by a team of health and social care professionals who worked closely with staff in providing people's care needs.

Is the service responsive?

When people who lived in the home made suggestions for changes these were actioned as far as practically possible. The service worked well with external healthcare professionals to make sure people received good standards of care. Records confirmed people's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. Regular audits had been carried out that enabled staff to make changes that could be of benefit to the people who used the service. Staff told us they were clear about their roles and responsibilities and the ethos of the service. Staff received regular supervisions by senior staff to ensure they were competent for their roles.