11 and 14 September 2015
During a routine inspection
This inspection was unannounced and took place on the 11 September 2015. A second day of the inspection took place on the 14 September 2015 which was announced in order to gather additional information.
Apple Court Care Home is a purpose built care home located in the centre of Warrington. It offers accommodation, personal and / or nursing care for up to 67 older people with memory problems associated with dementia. At the time of our inspection the service was providing accommodation to 51 people.
At the time of the inspection there was no registered manager at Apple Court Care Home. 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 home was previously inspected in April 2015. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safeguarding people from abuse and improper treatment; meeting nutritional and hydration needs; receiving and acting on complaints and staff training. We received a provider action plan which detailed that the provider would take immediate action to meet the relevant regulations.
We found that the provider had taken appropriate action to safeguard people from abuse and improper treatment. Likewise we found that the provider had taken appropriate action in response to complaints; meeting nutritional and hydration needs; receiving and acting on complaints; staff training and improved governance arrangements.
During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.
We found that registered person had failed to ensure that the people using the service were protected against the risks of unsafe or inappropriate recruitment practice as some key records had not been obtained.
Apple Court was being managed by two regional managers at the time of our inspection as the newly appointed manager was on annual leave. We have since been notified that this manager has resigned from post.
During the two days of our inspection, people living at Apple Court were observed to be comfortable and relaxed in their home environment and in the presence of staff.
People using the service and relatives spoken with were generally complimentary about the care provided at Apple Court.
For example, comments received included: “I feel safe and have no problems”; “I think it’s a lovely place”; “It is so clean. They clean everyday”; “They got the doctor out to my knee straight away”; “I am very well looked after. I couldn’t grumble about anything and the food is excellent”; “Staff are very good”; “You don’t go short of care”; “They respect you”; “Helping you isn’t too much trouble” and “We have new management. They are very open and honest about issues. They care and work hard.”
Some people raised concerns regarding the lack of activities, the use of agency staff and the standard of communication between staff. We have shared these concerns with the management team who assured us that they would take action to address the issues.
People using the service had access to a choice of wholesome and nutritious meals. Records showed that people also had access to a range of health care professionals (subject to individual need).
Systems had been developed by the provider to assess the needs and dependency of people using the service; to obtain feedback on the standard of care provided and to respond to safeguarding concerns and complaints.
We found that care planning records were in need of review to develop a more person-centred model. There was also conflicting information in some records which may have put people at risk. We also found that there remained some gaps on the training matrix and the quality assurance system was in need of review to demonstrate that the views of people using the service and their representatives were acted upon. We have made recommendations about these areas in the report.