Archived: Apthorp Care Centre

Apthorp Care Centre 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. Apthop care centre accommodates up to 108 people in ten flats each of which have separate adapted facilities. At the time of our inspection two of these flats had been decommissioned and 73 people were living in the home, many of whom were living with dementia.

There was no registered manager in post. 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 manager had started working in the service in late October 2018.

The provider had failed to sustain and embed previous improvements made in the quality and safety of the service. Although their systems had identified the failings we found in personalisation, risk assessments, medicines management, record keeping and the safety of premises they had failed to take effective action to address these concerns. The provider’s improvement plan was not driving improvements. The systems for involving people, relatives and staff in developing the service were not working effectively. While staff were optimistic about the potential for the new manager to make improvements, people and relatives were unclear about the management structure in the home.

There were not enough staff deployed to meet people’s needs. People told us they had to wait to receive care, and we saw people’s dignity was compromised as there were not enough staff available to support them in a timely manner. Bathrooms were dirty and this exposed people to the risk of harm due to poor infection control practice. Risks to people were not always identified, and risk assessments were not always followed. Medicines were not managed in a safe way.

People’s needs had not been assessed in line with best practice and resulting care plans lacked detail. The impact of people’s health conditions on their care preferences was not recorded and people’s dietary preferences were not always respected. The service had applied to the local authority to deprive people of their liberty under the Mental Capacity Act (2005) but we saw staff put in place additional restrictions on people’s liberty. Some areas of the home were not environmentally suitable for people living with dementia.

People’s dignity was not always upheld and the inspection team had to intervene on two occasions to ensure people’s dignity was restored. Care plans did not explore how people’s religious beliefs and cultural background affected their preferences for care. The service did not explore the impact of people’s sexual or gender identity on their experience of care services.

Records did not consistently demonstrate people had received care as planned or in line with their preferences. People had not been supported to explore their wishes for the end of their lives.

Staff recorded and escalated safeguarding concerns to ensure people were protected from abuse. People told us they were supported to attend healthcare appointments when they needed.

People told us staff were kind and we saw some positive, compassionate interactions between staff and people. People told us their privacy was respected and they were able to spend time alone with their visitors. Staff told us they took steps to maintain people’s independence and skills.

People gave us mixed feedback about the activities on offer. Some people enjoyed them and found them engaging, but other people did not find anything on offer that was suitable for them.

Some people knew how to make complaints, and records showed the provider followed their complaints policy in responding to concerns raised. However, other people did not know how to make complaints, and did not feel complaints were responded to appropriately.

We identified breaches of five regulations relating to person-centre care, safe care and treatment, premises and equipment, staffing and governance. Full details of our regulatory response are added to reports after all legal appeals are exhausted.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At a previous inspection in July 2016, we found the service to be inadequate overall. We placed Apthorp Care Centre into special measures and imposed a condition on the provider’s registration to submit monthly audit reports to the Care Quality Commission (CQC). Following the inspection in February 2017, although some improvement had been made, the service remained in special measures and the conditions on the provider’s registration remained in place.

This inspection was carried out within the six-month time frame to check if improvements to the quality of care had been implemented. At this comprehensive inspection we found the registered provider had taken action to achieve compliance with some of the regulations previously identified as non-compliant during the comprehensive inspection in February 2017. However, we found repeated breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

Apthorp Care Centre is a purpose built residential care home that is registered to provide accommodation for up to 108 people who require personal care. The home is split into three floors that contain units called 'flats'. At the time of our inspection there were 75 older people living at the home, many of whom were living with dementia.

There was a registered manager in place. 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.

At our last inspection we identified that staff were not effectively deployed around mealtimes. At this inspection we found that although there were sufficient staff on duty, at key times throughout the day such as mealtimes, we found that staff were not effectively deployed to ensure people received support with eating in a timely manner.

At our last inspection, we found that appropriate fluid monitoring records were not kept for people who were at risk of dehydration. At this inspection we identified repeated concerns in this area.

At this inspection, we found that although risk assessments were now identifying risks individual to people and staff were receiving appropriate guidance, some risks to people were, in practice, not actively mitigated against.

Improved systems and processes were in place to monitor quality of care. However, quality monitoring required further implementation and embedding.

Medicines were now safely stored and administered. Appropriate records were kept of medicine administrations and regular medicines audits took place.

Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure a better oversight of when staff training, supervisions and appraisals were due.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of the types of abuse to look out for and how to raise safeguarding concerns.

Care plans were person centred and reflected what was important to the person. Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's preferences.

Accidents and incidents were monitored and analysed on a monthly basis.

People engaged in a comprehensive activities programme delivered by dedicated activities co-ordinators.

People and relatives spoke positively of the caring nature of care staff.

The home was clean and well-maintained; however we identified a concern regarding water temperatures. The registered provider took immediate action to resolve the situation.

Consent to care was obtained from the appropriate person. Care plans specifying best interest needs were in place. Staff had received training on the Mental Capacity Act 2005 (MCA) and staff understood the importance of obtaining consent from people. Deprivation of Liberty Safeguards (DoLS) were applied for and monitored.

At this inspection we identified breaches of regulations. You can see what action we have asked the provider to take at the back of the full version the report. However, as the provider had demonstrated significant improvements, the service is no longer rated as inadequate for any of the five questions and therefore no longer remains in special measures.

Apthorp Care Centre is part of The Fremantle Trust. It is a purpose built residential care home that is registered to provide accommodation for up to 108 persons who require personal care. It is divided into three floors that contain units called 'flats'. All bedrooms are single rooms with en-suite facilities. At the time of our inspection there were 75 people living at the service who were older people, who were living with dementia or were people who have learning disabilities or who have autistic spectrum disorder.

There was 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.

At the previous inspection on the 6 and 12 July 2016 we found Apthorp Care Centre to be inadequate overall with five breaches of the regulations. As such the service was put into special measures. This meant that the service was kept under review and would be inspected again within six months. There is an expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. As such we inspected within six months on 1 February 2017 to identify if the provider had made improvements to the service.

At our previous inspection in July 2016 we found that medicines were stored in an unsafe manner that resulted in medicines being disposed of and replaced. During our inspection in February 2017 we found there was now safe storage of medicines. However although we found no errors in the general medicines administration we found omissions in the controlled drug procedure that was not being followed appropriately by staff.

At inspection in July 2016 we found risk was not well managed by the service as some people had no risk assessments and risk assessments were not reviewed to take account of changing circumstances. During inspection in February 2017 we found most people had up to date, detailed risk assessments. However we found people did not have assessments to manage the risk of diabetes and one risk assessment review although reviewed had not taken account of a recent fall.

In addition we found in July 2016 that there was no falls matrix or a system that investigated falls, injury or bruising. In February 2017 there was a system in place that was being used to track and investigate falls injury and bruising however we found one example of bruising not being followed up with an incident report as the procedure stated. Therefore we saw the system was not yet embedded in staff practice.

At our inspection in July 2016 we found that health assessment such as Waterlow (skin integrity assessments) and Malnutrition Universal Screening Tool (MUST) were not completed and reviewed on a regular basis. During the inspection in February 2017 we found that these assessments were now in place and reviewed. However we saw that health monitoring forms were not completed on occasions for people. As such the service would not have the information recorded to ascertain if people were being well hydrated and had adequate food consumption. This had not been picked up by the service’s monitoring systems.

Staff told us they were now receiving good induction and training but we found staff still were not receiving supervision sessions on a regular basis as per the providers’ policy.

At our inspection in July 2016 people told us staff were kind, caring and respectful. During our inspection in February 2017 people and relatives still spoke highly of staff and we saw some sensitive and kind interactions between staff and people. We also noted the atmosphere was warm and friendly and there was lots of laughter and fun between staff and people, an improvement on our previous inspection. However we found one person who was unkempt, was wearing stained clothing and we observed they were not responded to in an appropriate manner when they required support. The person’s care plan was incorrect and stated they spoke a specific language when in fact they did not. Staff did not know the language they spoke and understood, and it was not clear how they were being communicated with. As such their dignity was not being supported by staff.

In July 2016 we found that there was little or no management oversight of the day to day running of the service. In February 2017 people told us that the registered manager, who was appointed following our inspection in July 2016, had made good changes and was approachable. The registered manager was well respected by people, relatives and staff. We found that there were new posts created for three floor managers and a newly appointed deputy manager in addition to the previous care practice manager and assistant manager. This allowed for greater management oversight and accountability on the three floors. We found that the management team was newly formed but not all staff were clear of the new managers’ roles so whilst this was a positive step forward, time was required for the new management system to embed.

We saw one person was not supported to eat when they required encouragement from staff. A second person was unsupervised in a kitchen area when staff were otherwise engaged with people. The management team had not identified that meal times required further staffing to meet all people’s support needs.

In July 2016 audits had not identified the concerns found at our inspection. In February 2017 we found there was a new and comprehensive system being used by the registered manager to audit the service however had not long been in place and was not embedded in practice.

For example, they had not captured and addressed issued such as the lack of supervision sessions and the omissions in the controlled drug administration.

At inspection in July 2016 we found care plans were not in place on occasion and were not updated. In February 2017 we found that the management team and care staff had reviewed all the care plans since our last inspection and care plans were personalised, of a good standard and provided clear guidance for staff.

Activities had improved since our last inspection and we found a range of meaningful activities that people enjoyed. People who could not join in group activities were on occasion being encouraged to do activities in their ‘flat’ communal area or were visited by staff in their room.

During our last inspection people and relatives told us complaints were not responded to. During our inspection in February 2017 people and relatives told us they could complain and we saw evidence that complaints were recorded and responded to appropriately.

We found that there was a robust recruitment procedure that checked if staff were safe to work with vulnerable adults.

We found that improvements had been made in a number of areas and the service now requires improvement overall however remains inadequate in the Safe domain. This means that the Apthorp Care Centre will remain in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in Safe Care and Treatment, Good Governance, Staffing and Dignity and Respect.

We are taking enforcement action against the registered provider. We will report further on this when it is completed.

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

Apthorp Care Centre is part of The Fremantle Trust. It is a three-storey purpose built residential care home that is registered to provide accommodation for up to 108 persons who require personal care. It is divided into ten units called ’flats’. All bedrooms are single rooms with en-suite facilities. At the time of our inspection there were 93 people living at the service who were older people, who were living with dementia or were people who have learning disabilities or who have autistic spectrum disorder.

There was not a registered manager in post as they had resigned from their post in June 2016. There was an acting manager and the provider was in the process of recruiting 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 previous inspection on 22 July 2015 the service had been found to be Good overall. However in the inspection prior to this in October 2014 the service was found to be Inadequate overall.

People told us they felt safe at the service however we found a number of concerns that put people were at risk of harm. People told us they received their medicines in a timely manner and that staff asked if they needed pain relief. We found no errors in people’s medicines administration records but medicines were not being stored in a safe manner in some of the units and we had to ask the service to take urgent action to make sure medicine was being stored safely.

We found that although most people had risk assessments, some risk assessments had not been updated after a change in circumstances, for instance when people had serious falls that had affected their mobility the falls risk assessments were not updated. Also one person did not have a robust risk assessment in place to protect them from other people who had behaviours that were difficult to manage. We found two people did not have risk assessments in their records in addition to lacking most of their care and support plans even though they had been living in the service since January and May 2016. This meant the service did not have systems in place to keep people safe.

Falls and injuries were not being adequately recorded and were not investigated in a robust manner and there was no falls matrix to identify if a person was falling for a specific reason or if there were trends in the service that was contributing to falls.

The provider undertook robust recruitment practices to ensure staff were safe to work with vulnerable adults.

We found that some staff had not received supervision for several years. In addition although some core training had taken place, training records were not well kept and it was not possible to identify what training staff had received or when they were due for refresher training. This meant that staff were not being supported to undertake their caring role.

Health assessments such as Malnutrition Universal Screening Tool (MUST) and the Waterlow Assessment (for good skin integrity) were not completed and reviewed on a regular basis. Therefore the service was not ensuring people’s nutritional needs were being met and did not consistently record people’s weight to ensure their nutritional intake was adequate.

We observed people being supported to eat tastefully prepared pureed meals in an appropriate manner however it was not consistently recorded why people required a pureed diet and one person’s records were not completed to show staff had supported them appropriately to eat.

Staff were able to tell us how they got people’s consent before offering care and support. The service had undertaken mental capacity assessments and made Deprivation of Liberty Safeguards (DoLS) applications appropriately to ensure they were working under the Mental Capacity Act (2005) to ensure people’s legal rights were being upheld.

People said that most staff were very good and caring although relatives had mixed views about staffing numbers and staff’s manner towards people. We saw mostly positive and sometimes sensitive interactions by staff.

The service did not facilitate people or their visitors to complain as there was no information displayed telling them how to complain. There had been very few complaints recorded and these were all with the exception of one complaint not investigated thoroughly.

There were some varied group activities and special events but only some people could attend. There was not varied individual activities or meaningful activities within each unit.

The service was not well led. Policies and procedures were not up to date and were not accessible to staff. Audits had taken place but these had failed to identify the number of ineffective systems in the service.

The provider had started to reorganise the management structure in the service to include floor managers that have a responsibility for the units on a specific floor.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider. We will report further on this when it is completed.

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

During this follow-up inspection we spoke with ten people who used the service and nine members of staff.

We noted that a new manager had commenced employment at the Home in January 2014.

We observed that since our inspection on 19 November 2013, the provider had made various improvements which included introducing a new format of care and support plans, risk assessments and a new activities timetable.

During our follow-up inspection on 10 March 2014 we were concerned that there were not sufficient numbers of staff on duty during the night shift. We raised this with the provider and they informed us that they had immediately put an extra member of staff on duty during the night shift and provided us with evidence to confirm this.

During this inspection, people said they were treated with respect and dignity and they appeared well cared for. They had been provided with choices regarding meals provided and their likes and dislikes had been recorded.

People were treated and spoken to with respect by staff and were encouraged to be independent around the home. People were well dressed and relatives of people who used the service told us they were very happy with the care provided. However, we found that people were not always involved in planning their care and treatment and were not always able to choose what they wanted to eat or drink.

We observed that staff used correct moving and handling techniques and treated people with care and respect at all times. However, we found that people did not have a sufficient number of activities to participate in and were left watching the television or sleeping for periods of time. We also found that people who had been assessed of being at risk of falls or pressure ulcers had no appropriate plan in place to suitably manage or reduce these risks. There were not always enough staff to fully meet people's needs and this meant that there were insufficient interactions or that people had to wait for their care and treatment.

Staff had received appropriate training and supervision to ensure that people were kept safe and the provider had systems in place to identify and manage risks in the home.

On the day of our visit we saw people participating in community art sessions, organised as part of an external art project. People's preferences in terms of likes and dislikes were respected and they felt involved.

There were no systems in place for assessing and monitoring the number of falls incidents involving people who use the service. Records held by the service show several instances of falls incidents during October 2012.