We carried out a previous comprehensive inspection on 12 and 15 June 2017. The service was rated Inadequate and was placed into special measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We told the provider to make improvements to ensure people’s medicines were managed safely, that the environment was checked to ensure it kept people safe, and risks associated with people’s care were recorded. We also told the provider to ensure staff had the necessary training to be able to safely and effectively support people, that people’s human rights were protected in line with the Mental Capacity Act (MCA) 2005, and that people’s care records showed their involvement in decisions relating to their care. As well as being kept up to date and in line with their wishes and preferences. Action was also required to ensure people had enough to stimulate their social and cognitive needs, and that people’s privacy and dignity was respected, particularly at the end of their life. In addition, we requested the overall management, leadership and culture of the service should be improved and asked the provider to implement an effective monitoring process, to help capture people’s views and identify when improvements were required.
Immediately after our inspection, the provider told us they would stop new admissions to the service, in order for them to put things right. We also contacted the local authority safeguarding team who took prompt action to ensure people's health, safety and wellbeing.
The Commission considered its enforcement policy, and took enforcement action, which was to impose a condition on the provider's registration. This meant on a monthly basis, the provider was requested to carry out an audit of people’s care plans and risk assessments, the management of people’s medicines, and equipment and environmental maintenance. Submit a summary of their findings to the Commission, and demonstrate what action was being taken to improve the service and to meet regulation. Since October 2017 the Commission had been receiving and reviewing the provider's monthly returns, which had demonstrated ongoing improvement at the service. However, during our most recent inspection although we found some improvements had been made, our findings relating to people’s care plans, risk assessments and medicines management showed the information which had been provided had not always been fully accurate. This demonstrated the providers auditing systems had not always identified where improvements were required and continued to require adapting.
During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures, but further improvements are still required. The Commission also made a decision to remove the providers imposed condition of registration.
We carried out an unannounced comprehensive inspection on 29 January 2018 and 08 February 2018.
Appleby Lodge 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 care home provides accommodation for up to 18 older people who require personal care. The provider also operates a day centre offering meals and companionship to local people. The service is on one level. There are shared bathrooms, shower facilities and toilets as well as a lounge and dining area. There were 15 people living at the home at the time of our inspection and one person using day care facilities.
Since our last inspection the manager had now registered with the Commission and was now the registered manager of the service. 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.
Overall, people’s medicines were now managed safely. However, people who required medicines at particular times did not always have care plans in place for staff to follow, to help ensure they received these in line with prescribing guidelines. People, who had pain relief patches applied to their body, did not have records in place to detail where they had been applied. Meaning, people may not always receive consistent medicine support. The registered manager and provider had introduced a new audit to help highlight where improvements were required. Whilst the use of this audited had seen a positive impact in driving improvement, it had failed to identify where some improvements were required.
Overall, people now lived in an environment which was assessed to ensure it was safe. Fire checks were being carried out as required. However, some risks had not been assessed to ensure people’s safety, for example hot water in two bathrooms and in one person’s bedroom was found to be very hot.
People's accident and incidents were recorded which helped to provide a good overview of when a person had experienced unavoidable harm, so themes could be identified to help minimise it from occurring again. However, when a theme had been identified people’s care records were not always updated. This meant the person may not receive consistent care because the information had not been recorded for staff to read.
People told us they felt safe living at the service. People were protected from abuse because the provider’s processes and procedures kept people safe. People were supported by suitable numbers of staff to ensure their needs were met. People’s call bells were answered promptly and the provider had created a new staffing dependency tool which would help to assist with ensuring there were, enough staff to be able to meet people’s needs safely.
People lived in a clean and odour free environment. Staff received infection control training and implemented their knowledge and training. Whilst, laundry was handled in the correct manner the laundry area was found to be cluttered with flooring which could not be washed easily.
People now received care from staff who had undertaken training to help meet their individual
needs. Overall, people’s human rights were protected, but when someone did not have the mental capacity to make certain decisions, such as in respect of their care this was not always detailed within their care plan to enable the person to be supported effectively. People's consent to care was now obtained and was documented in care plans and people were asked for their permission prior to being supported.
People’s individual communication needs were known by staff and staff knew people well. However, the recording of this information was not always detailed in people’s care plans to help ensure a consistent approach.
Overall people were pleased with the food. The chef told us there was always flexibility and people could have what they wanted. People’s like and dislikes were now recorded, and the menu had been re-created by taking account of people’s preferences. People were supported with their nutrition, and now had care plans in place to help guide staff to deliver the correct support. People were supported to live an active life, but many chose not to.
People received a co-ordinated approach to their care. Health and social care needs were assessed on an ongoing basis, to help ensure their care and support needs were being met in line with best practice. The GP who visited the service was complimentary of the care provided.
People lived in a service which was adapted to meet their needs. The provider had recently replaced the dining room chairs so they were easier for people and staff to move, whilst they were seated.
People's privacy and dignity was now respected. Staff spoken fondly of the people they supported and used sensitive and appropriate language to describe people’s care needs. People and their families, told us staff were kind and caring. People told us they were now satisfied with the laundry service.
People’s individual equality and diversity needs were known, and respected. People’s care plans now demonstrated how people were being actively involved in making decisions about their own care and support.
People now had care plans in place to help provide guidance and direction to staff about how to meet their needs. Care plans were reviewed when changes occurred in people’s care and/or on a monthly basis.
Overall, people would be supported respectfully at the end of their life, because staff had received training in palliative care. However, people’s end of life care plans were not individualised to help ensure staff knew what people may specifically wanted.
The registered manager helped to reduce people’s social isolation by consulting with people about what they wanted to do. People’s comments and complaints were respectfully listened to, and used to help improve the service. The provider’s complaints policy may not have been in a suitable format for everyone to understand.
The provider now had more of an active role and was visible within the service. The registered manager told us they received good support, and that the provider was at the service on a day to day basis, speaking with people and staff to ensure they were satisfied with the service.
People lived in a service whereby the registered manager and provider were continually learning which helped to adapt and improve the service. The registered manager and provider kept their professional knowledge up to date. They also told us they kept up to date with regulatory changes by