Archived: Cuerden Developments Limited - Appleby Court

We found the following examples of good practice.

The service had updated their policies and procedures to ensure infection prevention and control (IPC) processes were robust. All visitors had their temperatures checked, asked about any COVID-19 symptoms and were required to complete a ‘track and trace’ form, in order to contact visitors should there be an COVID-19 outbreak after their visit.

Donning and doffing stations were situated in the service and personal protective equipment (PPE) was available throughout the building. Staff had designated areas to change into their uniforms and all staff had received training in IPC and PPE in relation to COVID-19. When agency staff were required, the same staff member was block booked, had their temperature taken and tested for COVID-19 upon arrival to work. People and staff received regular COVID-19 tests.

The service was conducting regular infection control audits, to ensure infection prevention and control (IPC) processes were robust. Cleaning processes had increased throughout the service and cleaning products had been confirmed as suitable to tackle COVID-19. High touch surfaces were regularly cleaned, and checklists were in place.

Appleby Court is a care home which can accommodate up to 61 older people who need residential or nursing care across two floors. At the time of our inspection 54 people were living in the home.

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

The registered manager's ethos was to place people at the heart of the service. They firmly believed that people should be 'heard' and listened to. They advocated for people and supported them to express their views to external health and social care professionals to have certain decisions over-turned and restrictions removed.

Staff fully believed in the registered managers vision to promote person-centred care and were proud to work for the service. They told us the registered manager's visibility around the home and their 'open-door' policy made them feel well-supported and involved.

Risks to people had been identified and assessed with guidance in place for staff to follow to ensure people did not come to harm. Staff knew how to recognise signs of abuse and were confident reporting any concerns they may have. People told us they felt safe and family members were reassured their relatives were well looked after. People’s medicines were managed safely by trained staff and guidance was in place for people who received medicines ‘as required’.

There were enough suitably qualified and trained staff to meet people’s needs safely and effectively. Staff commented on the teamwork they had and how they supported each other especially during busy times. They told they felt they had time to sit with people and spend quality time with them.

People’s needs had been assessed and plans were in place to help manage these. Staff commented on how easy the care plans were to follow and how the information they contained helped them to support people.

People had access to other health and social care professionals when needed and staff followed the guidance they provided. People were supported to maintain a healthy balanced diet and spoke positively about the food provided. All staff had good knowledge of people’s individual dietary needs and preferences and provided people with the support they needed during meal times.

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.

People and family members spoke positively about the caring nature of all staff and told us they were "gentle" and "reassuring". Family members told us how welcome they were made to feel and that staff often took time to chat with them. Staff had developed positive relationships with people and provided care and support that was person-centred and based on their needs and choices.

A full time activities coordinator supported people to access a range of activities. Their 'bubbly' personality helped to 'bring people to life' and had developed positive relationships with them.

People and family members spoke positively about the management of the service. Effective systems were in place to monitor the quality and safety of the service and the registered provider was keen to improve the quality of care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection - The last rating for this service was good (report published 27 July 2017)

Why we inspected - This was a planned inspection based on the previous rating.

Follow up - We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cuerden Developments Limited – Appleby Court Care Home is a purpose built, two storey care home which provides both nursing and residential care for a maximum of 81 people. At the time of the inspection there were 67 people using the service.

The service had 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.

People received safe care. People received their medicines in the way that had been prescribed for them. People's individual care and support needs were met and systems were in place to protect people from abuse and avoidable harm. Risks to people's health and wellbeing were identified, managed and reviewed. There were enough staff available to meet people's needs who had been employed in line with the provider's safe recruitments procedures.

The care that people received continued to be effective. People made decisions about their care and staff sought people’s consent. Where people lacked capacity they were helped to make decisions. Where their liberty was restricted, this had been identified and action taken to ensure this was lawful. People received supported with their health care and nutritional needs. Staff received training to meet the specific needs of people who used the service.

The care people received continued to be good. People were treated with dignity and staff were caring and kind. Staff helped people to make choices about their care and their views were respected. The care records detailed how people wished to be cared for and people received individualised care and support that met their needs.

The care people received continued to be responsive. People were involved in the care and support they received and relatives continued to play an important role. Where people had any concerns they were able to make a complaint and this was responded to.

The service continued to be well-led. Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service on how improvements could be made. The manager promoted an open culture which put people at the heart of the service.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at respect and involvement, care and welfare, staffing, quality assurance and complaints.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families and looking at records:

Is the service caring?

During the visit we saw staff offering care and support in a polite and courteous manner. Staff were patient and friendly and made efforts to ensure people's dignity and privacy were preserved at all times.

The home had a range of ways for people who used the service to voice their opinions, offer suggestions and raise concerns. There were six monthly questionnaires, from which the results were analysed and any issues addressed. There were also six to eight weekly relatives meetings, a monthly newsletter and regular communication between staff and people who used the service and their visitors. The manager had an open door policy so that people could speak with them whenever they wanted to.

There were a number of activities on offer, such as trips out, exercises, reminiscence, games and entertainment. We spoke with five people who used the service and two visitors. They were all positive about the home and the staff. One person said, 'I'm champion, I like this place. They (the staff) are mostly nice. They take me into Wigan once a week'. Another person told us, 'You get a good laugh with them (the staff) and they are helpful. If you want something they will help you in any way they can'. Others were also positive about the care they received, activities undertaken and the home in general.

Both visitors with whom we spoke felt their relatives were well looked after. One commented, 'I am quite pleased with the home. They have been very helpful and I appreciate their help. I've not found anything to find fault with'.

Is the service responsive?

We saw that staff responded promptly to summons by call buzzers from people who used the service.

Thorough assessments were carried out prior to them moving in to ensure their needs could be met and the placement was appropriate. We saw a new document for recording personal information, social histories and personal preferences in an effort to make care more person centred and individual.

We saw evidence that changes had been made, to activities and menus, in response to concerns raised and suggestions made by people who used the service.

Care plans and risk assessments were reviewed and updated regularly and changes made as necessary to ensure they reflected people's changing care needs.

Is the service safe?

There were sufficient numbers of staff on duty at the home on the day shift, but rotas, staff comments and dependency levels of people who used the service showed that staffing levels were inadequate on the nursing units on the night shifts.

Although no one was currently subject to Deprivation of Liberty Safeguards (DoLS), the manager demonstrated a good knowledge of the subject which would help ensure people were deprived of their liberty only in their own best interests and with the least possible restrictions. The manager had ensured that they were up to date with the local authority guidelines and the recent changes.

Staff training was up to date and on-going and staff with whom we spoke had a good knowledge of the care planning process and how to deliver care in accordance with individual care plans.

Risk assessments, such as falls, nutrition and moving and handling were in place in the care records and were reviewed and updated regularly to ensure people's needs were met safely.

Health and safety checks were carried out regularly and all equipment was well maintained. The manager had plans in place to complete Personal Evacuation Plans (PEEPs) for all individuals so that staff and emergency service personnel would be aware of the level of support required by each person in the event of an emergency.

Accidents and incidents were appropriately recorded and followed up and lessons learned in order to help minimise the risk of further similar incidents in the future.

Is the service effective?

Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities.

Care plans we looked at included factual and up to date information about people's health and support needs.

Recent questionnaires filled in by people who used the service indicated a high level of satisfaction. Residents and relatives meetings had proved popular and were well attended. We saw suggestions, concerns and ideas had been taken on board and responded to by the home.

The people who used the service with whom we spoke felt the care provided was effective and appropriate. We spoke with two visitors who agreed that their relatives were cared for appropriately and well.

Is the service well-led?

The home had a manager in place, who was appropriately registered with the Care Quality Commission.

A range of audits and checks were in place at the home to help ensure consistent standards of care within the home.

Questionnaires were regularly completed with people who used the service, to gain their opinions and suggestions and gauge their level of satisfaction. Results were analysed and used to inform continual improvement to the service.

Complaints were dealt with in a timely and appropriate manner.

The people using the service who were able to tell us said that they were happy living in the home and that the staff members were good. Comments included; 'as good as it could be, staff are good' and 'staff are looking after me', 'angels, so kind', 'staff are excellent, definite improvement with the new manager', 'staff are very nice' and 'staff are absolutely brilliant, very friendly'.

The visitors we spoke with also made positive comments including, 'I am always made to feel welcome' and 'staff are looking after her well'.

There were effective recruitment and selection processes in place and all new staff members completed an induction training programme so they had the skills they needed to do their jobs effectively and competently.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis via feedback from the people who used the service and their representatives, including their relatives and friends.

We found the people were well cared for and that staff always asked for permission to start care tasks. One person told us 'The staff are polite and always ask me what I want before giving me any care.'

We found that there were effective systems in place to prevent and control infections within the home. We observed good hand hygiene practice and saw the appropriate protective equipment was worn by staff at the correct times.

We found that staff were happy working at Appleby Court and that they had received relevant training. They told us that they were supported in their role and that the manager was approachable.

We saw that there were appropriate systems in place to monitor the quality of care that people received the home. We found that accident and incidents were reported and monitored and that the provider responded to any complaints made by people.