Appleby Court Care Home

Updated 18 May 2023

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The first day of the inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day of inspection was carried out by 1 inspector.

Service and service type

Appleby Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post. A manager had been appointed and had applied to CQC to become the registered manager.

There is a nominated individual appointed by the provider. The nominated individual, referred to in the report as the providers representative, is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

The first day of the inspection was unannounced and the second day was announced.

What we did before the inspection

We reviewed all the information we held about the service since it registered with the Commission. We also obtained information about the service from the local authority and local safeguarding teams. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 5 people and 2 family members about their experience of the care provided. We also spoke with the manager, deputy manager, 6 care staff, 2 nurses, the maintenance person and 3 ancillary staff.

We reviewed a range of records. This included 4 people’s care records and a selection of people’s medication records. A variety of other records relating to the management of the service, including audits and checks were reviewed.

Updated 18 May 2023

About the service

Appleby Court is a care home providing accommodation, personal and nursing care for up to 60 people; some of whom live with dementia. Accommodation is provided over two floors each of which have separate adapted facilities. At the time of our inspection 19 people were using the service and all were accommodated on the ground floor.

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

Risk assessments and care plans were completed on a new electronic care planning system introduced since the last inspection. Risks to people's health, safety and wellbeing were set out in their care plans along with guidance for staff on how to provide people with safe care. Records used to monitor risk included the required information about people’s needs and how they were to be met.

Safe infection prevention and control (IPC) procedures were followed. The safety, hygiene and cleanliness of the environment, equipment and utilities were monitored through regular checks and audits.

Managers and staff understood their responsibilities in relation to safeguarding people from the risk of abuse. Allegations of abuse were referred to the relevant authorities without delay and safeguarding records were well maintained. People told us they felt safe and family members confirmed this. Records confirmed there had been an increase in the completion of safeguarding training since our last inspection.

Medicines were managed safely stored and administered by staff who had the necessary skills and competence. Medication administration records (MARs) were overall well kept, however handwritten information entered onto some people’s MARs had not been signed by the scriber and checked by a second person to ensure the accuracy of the information recorded in line with best practice. The manager addressed this immediately.

Systems were in place to record and analyse accidents and incidents. Records were well maintained, and the outcome of reviews were shared with staff to ensure learning from incidents took place.

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.

A manager had been appointed to work at the service since our last inspection. They commenced this post in February 2023 and had applied to the Care Quality Commission (CQC) to become the registered manager.

Systems and processes for assessing, monitoring, and improving the quality and safety of the service had improved. Newly implemented checks and audits were completed across the service and areas identified for improvement were actioned. There was improved oversight of the service on behalf of the provider. Monthly meetings were held with managers and the provider’s representative where key areas of the service were discussed and evaluated. Action plans were developed for any areas where audits identified improvements were required.

Records relating to people’s care and the running of the service had improved. They were well maintained and regularly reviewed to make sure they were accurate and up to date. People, staff, and family members were provided with opportunities to feedback about their experiences of the care provided. There was improved partnership working with others including external health and social care professionals.

There were enough suitably skilled and qualified staff on duty to meet people’s needs and keep them safe. No new staff had been recruited since the last inspection; however, policies were in place to ensure staff were recruited safely. Checks were carried out to assess the fitness and suitability of agency staff. Nurses’ personal identification numbers (PINs) were checked monthly to make sure they remained valid.

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 inadequate (published 14 October 2022) and there were 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.

This service has been in Special Measures since October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 8 and 13 September 2022. 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 safe care and treatment 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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to 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 Appleby Court Care Home on our website at www.cqc.org.uk.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.