We carried out a review of the data available to us about Applecroft Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Applecroft Care Home, you can give feedback on this service.
People were supported to stay safe when they met their friends and/or family members. At the time of the inspections normal visiting had been suspended due to a COVID-19 outbreak. Essential care givers and relatives of people on end of life care where welcomed. The service was following government guidelines.
Visitors phoned to arrange a time to visit; they were asked to complete a COVID-19 test before entering the service. On entering the building visitors were asked for prove of a negativeCOVID-19 tests, their temperatures were taken and a health declaration completed. Plans were in place to isolate people and keep people separate when they had tested positive COVID-19 to reduce the risk of transmission
Stocks of the right standard of personal protective equipment (PPE) were well maintained and staff used and disposed of it correctly. Guidance on the use of PPE and current IPC procedures were clearly visible across the service and available in picture format.
People and staff members had an individual risk assessment so that care and support could be tailored to everyone’s individual requirement.
Staff had received training in infection control to keep people safe. Staff completed regular testing for COVID-19 as per government guidance. There was a clear and robust cleaning schedule in place. The building was clean and odour free.
Applecroft Care Home is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.
Applecroft Care Home is registered to provide accommodation, nursing and personal care for 75 older people and people who live with dementia. There were 67 people living in the service at the time of our inspection visit. The service was divided into five self-contained units or wings. These units were called Permain, Discovery, Blossom, Russet and Pippin.
The service was run by a company who was the registered provider. There was a 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. In this report when we speak about both the registered provider and the registered manager we refer to them as being, 'the registered persons'.
At the last comprehensive inspection on 29 February 2016 and 1 March 2016 the overall rating of the service was, 'Good'. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found that the service remained, 'Good'.
People were safeguarded from situations in which they may be at risk of experiencing abuse. Risks to people's safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Medicines were managed safely. There were enough nurses and care staff to provide people with the care they needed. Background checks had been completed before new nurses and care staff had been appointed. Measures were in place to prevent and control infection and lessons had been learned when things had gone wrong.
Care was delivered in a way that promoted positive outcomes for people. Nurses and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included providing reassurance to people who lived with dementia if they became distressed. People were supported to eat and drink enough to have a balanced diet to promote their good health. Suitable steps had been taken to ensure that people received coordinated care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. People were supported to have maximum choice and control of their lives. The registered persons had also taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. Policies and systems in the service supported this practice. Parts of the accommodation were not fully designed, adapted and decorated to meet people’s needs. However, plans were in place to address these shortfalls.
People were treated with kindness, respect and compassion. They had also been supported to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.
People received personalised care that promoted their independence. Information had been presented to them in an accessible way so that they could make and review decisions about the care they received. People were supported to pursue their hobbies and interests. The registered manager, nurses and care staff recognised the importance of promoting equality and diversity. There were arrangements to ensure that people's complaints were listened and responded to in order to improve the quality of care. Suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.
The registered manager had promoted an open and inclusive culture in the service to ensure that regulatory requirements were met. People who lived in the service, their relatives and care staff were actively engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The registered manager was actively working in partnership with other agencies to support the development of joined-up care.
There are three units:
Discovery Unit on the ground floor supports people who may have behaviours that challenge, may have dementia and may also have pre-existing mental health disorders.
Permain Unit on the first floor supports older people who may be living with dementia at various stages which ranges from mild to advanced.
Russet and Pippin Unit on the second floor is a general nursing unit.
The service is run by a registered manager who was present during our inspection. 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 is supported by a deputy manager and unit leads.
We carried out an unannounced comprehensive inspection of this service on 20 and 22 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the service wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.
People told us that they felt safe living at the service. One person said, “Feel safe because the staff always help me”. People looked comfortable with other people, staff and in the environment. Staff understood the importance of keeping people safe. Staff knew how to protect people from the risk of abuse and how to raise any concerns they may have.
Risks to people’s safety were identified, assessed and managed appropriately. People received their medicines safely and were protected against the risks associated with the unsafe use and management of medicines. Accidents and incidents were recorded and analysed to reduce the risks of further events. This analysis was reviewed, used as a learning opportunity and discussed with staff.
Recruitment processes were in place to check that staff were of good character. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff. The deployment of staff on the Permain unit during mealtimes to ensure people receive the required level of support is an area for improvement.
People were provided with healthy food and drinks which ensured that their nutritional needs were met. People’s health was monitored and people were referred to and supported to see healthcare professionals when they needed to.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Applications for DoLS had been made in line with guidance and authorised DoLS and were continually reviewed.
People and their relatives were involved with the planning of their care. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Staff knew people well and reacted quickly and calmly to reassure people when they became agitated.
The building and grounds were adequately maintained. However on the first day of the inspection there was a strong odour of urine on the Permain unit and on the Russet unit. This was an area for improvement.
People were supported by staff to keep occupied to reduce the risk of social isolation. People, their relatives, staff and health professionals were encouraged to provide feedback to the provider to continuously improve the quality of the service delivered. People knew how to raise any concerns and felt that they would be listened to and that actions would be taken.
Staff had an in-depth appreciation of people’s individual needs around privacy and dignity. Staff were motivated to provide kind and compassionate care to people and felt it was very important to also support people’s relatives.
The registered manager, deputy manager and unit leads coached and mentored staff through regular one to one supervision. The registered manager spent time with the staff in each unit each day to maintain oversight of the service. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the management team.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.
This was an unannounced inspection carried out on 20 and 22 January 2015.
Applecroft Care Home provides nursing and personal care for up to 75 older people some of whom may be living with dementia. The service, which is owned by Abbey Healthcare, is situated in River near Dover with accommodation on three floors. On the days of our inspection there were 55 people living at the service.
There were three units:
Discovery Unit on the ground floor supports people who may have behaviours that challenge, may have dementia and may also have pre-existing mental health disorders.
Permain Unit on the first floor supports older people who may be living with dementia at various stages which ranges from mild to advanced.
Russet and Pippin Unit on the second floor is a general nursing unit.
The service was run by a registered manager who was present during our inspection. 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.
People were at risk of receiving unsafe or inappropriate care arising from a lack of proper information because records were not accurate and not completed consistently. Care plans did not always contain up to date information. Where people’s needs had changed this had not always been recorded in a timely manner so staff may not be aware of changes.
People’s rights were not always protected because although assessments were carried out, to check whether people were being deprived of their liberty and whether or not it was done so lawfully, no applications had been made. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Assessments had been completed but no applications had been submitted to the local authority in line with this guidance. We have made a recommendation about DoLS.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests.
Recruitment processes were in place to check that staff were of good character and there were sufficient numbers of staff to meet people’s needs. Staff knew how to protect people from the risk of abuse and how to report any concerns they may have. People were supported to take their medicines safely.
Staff were aware of the culture and ethos of the service and told us that they were involved in the continuous improvement of the service.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Staff were caring and compassionate. Each person was allocated a named nurse who took the lead and co-ordinated their care.
People were provided with a choice of healthy food and drink which ensured that their nutritional needs were met. People’s physical health was monitored and people were supported to see healthcare professionals.
The design and layout of the service was suitable for people’s needs. There was wheelchair access and the building and grounds were adequately maintained. All the rooms were clean, spacious and well maintained. The provider had systems in place to monitor the quality of the service. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.
The service was safe, and now clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.
We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.
Staffing levels were now being maintained to ensure that people had the support they needed.
Is the service effective?
People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.
Is the service caring?
We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as “the staff are very nice”. A relative said “The staff are very good with X and staff member X is brilliant, really hard working”. Another visitor said “It is much better than it was. We are much happier now.”
Is the service responsive?
We found that the staff listened to people, and took appropriate action to deal with any concerns.
Records showed that the service was responsive to people’s changing needs. For example, when a person lost weight an appointment was made with the person’s doctor and referral made to a dietician.
Is the service well-led?
The company and the manager had systems in place to provide ongoing monitoring of the home. This included care plan reviews, and checks for the environment, health and safety, fire safety, staff training needs and medication audits.
The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving. This showed that there were reliable systems in place to provide oversight for the service, and effective leading by the management.
Before and during the inspection we spoke with or had information from visiting relatives. We spoke with various staff on the unit over the two days and with the manager and clinical manager. We carried out observations in the lounge area and on the second day of the inspection, toured some of the unit with the manager.
We had contact with some staff from the local authority social services department who had been monitoring the service and information from visiting health professionals.
We found that parts of the unit were not clean and hygienic. This posed a risk to people using the service.
We found that there were not sufficient numbers of staff to meet people’s needs leading to a risk of neglect.
Staff, people using the service and relatives told us that they felt that more staff were needed. Several new staff had been recruited and there were plans in place to review the current staffing levels. Arrangements were in place to cover staff sickness and leave so that staffing levels did not fall below a certain level. This ensured that the service was safe. We found that staff were present in communal areas and available when people needed them. We judged that there were sufficient staff in two of the three units. In the third unit there were times when people had been left unattended as all the staff had been supporting one person. In light of this, the staffing levels on this unit were being reviewed.
We found that people were involved in their care and treatment and were asked about their preferences. People were supported to make choices and decisions about their care and support.
Each person had a care plan that was individual to them and that was person centred. Care plans had specific detail about how to meet the person's needs. Potential risks were identified and assessed. This included the risks of malnutrition, dehydration, pain and sore skin. The service worked proactively and took action to help maintain people's health and well-being.
A relative told us 'The standard of care is good. The staff are good and my relative is well looked after.'
A person using the service told us 'The girls (staff) are lovely. I am so much better since I have been here. They know how I like my tea and they make it just right.' Another person said 'I do like being here and like the singing' and 'They get the doctor when I need him, they look after me in that respect'.
We found that the care records had been recently reviewed and updated, and were now easier to navigate, although we noted that some assessments were inconsistently filed. This meant that new staff may find it difficult to locate current assessments and information about the person's care.
We spoke to staff members who told us that the staffing levels had recently been increased, and this had made it easier for them to meet the needs of the people at the home. We saw that call buzzers were answered promptly, and that staff had time to talk to people as well as deliver care.
During our visit we found that staffing levels had been reinstated so that there were sufficient staff to meet peoples' needs on all three units.
Many of the people using the service had complex needs which meant they were not able to tell us their experiences. We used a number of different methods to help us understand the experiences of people using the service. These included using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
People who use the service said or showed us that the staff treated them with respect and supported them to raise any concerns they had. They said or showed us that they received the health and personal care they needed and that they were comfortable in their home.
One person said, 'The staff are very good. I am happy with everything. My room is lovely and comforting'. Visiting relatives told us that they were happy with the service and that the home was clean. One relative said 'I have no concerns at all. I always come unannounced and my relative is always up, washed and dressed and in the lounge, so not in his room. The staff are really good'.
People expressed that they were relaxed and happy at Applecroft. People were dressed in their own clothes and were clean and looked well cared for.
People were relaxing in various parts of the unit.
The atmosphere was calm and relaxed.
Staff were supporting people discreetly and with kindness and understanding.
Staff spoke with knowledge about peoples' needs.
Records were up to date and gave staff guidance about how people wanted to be supported.
Everyone we spoke to said good things about the staff like 'they are kind' and 'the staff are excellent'. People said that they thought that there were enough staff on duty.
Everyone we spoke to said that the food was good and that they were happy with their bedrooms.
People's relatives told us that they were satisfied and happy with the service. One person said that their relative had been unwell and staff made sure that they saw a doctor.
Since our last inspection, the provider had sent us an action plan about how they intended to improve outcomes for people using the service.
The people that use the service at Applecroft have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.
We carried out two SOFI observations in two different parts of the home. Overall we people had positive experiences. In the morning we were in the lounge at the Discovery unit. We saw that people were occupied with a variety of activities. Staff were attentive, responding positively when they were approached and gave lots of encouragement to people. One of our observations was carried out at lunchtime in Russet and Pippin units. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own.
Staff were all busy and different staff members, visiting professionals and a relative told us that they felt that there were not sufficient staff on duty to give good quality care and support.
Some people had been upset by incidents of challenging behaviour which some people felt would have been prevented by having more staff on duty. Some people had no choice about getting up and were still in bed at 11.45am due to inadequate staffing levels. The people in bed had been made comfortable but had to wait until the staff had the time to get them up.
A visiting carer told us that their relative seemed to be very hungry in the afternoon and they felt that this was due to the staff not having the time to sit with them and help them to eat during the day.
The company reacted to this by increasing the staffing levels on one of the four units by one carer due to start on the day after our visit.
A visiting carer told us that they were generally happy about their relative's care and treatment. They had complained by using a complaints book about things like items of clothing going missing and each time their complaint was addressed. They said that staff always sought advice about medical problems quickly.