The inspection visit at Appleby Grange was undertaken over two days the 31 July and 01 August 2017 and was unannounced. Appleby Grange is a care home with nursing that is registered for 27 people. The service supports people who need nursing care and live with dementia. The building is on one floor and rooms have en-suite facilities. The home has separate lounges and dining rooms. The garden areas are accessible for people in wheelchairs with seating available for people who live at the home. Car parking facilities are available.
This is the first inspection at Appleby Grange following the new providers registration details with the Care Quality Commission (CQC).
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.
The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults. Training records looked at confirmed this.
Medicines, including controlled drugs, were stored in a clean and secure environment. We observed nursing staff followed correct procedures when they administered medication and fully completed records. Control drugs were in use and correct storage and record keeping was in place.
We looked at staff training records and the registered manager’s training matrix and found staff received a wide range of training to support them in their role. Staff informed us access to training was good and one said, “Always supported to further your development by doing training courses and professional qualifications.”
We found recruitment checks were carried out to ensure suitable staff were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members, our observations during the two days visit, looking at staffing rotas and recruitment documentation.
During the inspection visit we observed people having their meals where they chose to. People who lived at the home could have their breakfast at any time and where preferred. This was confirmed by talking with people. Comments were very positive about the meals at Appleby Grange, one person who lived at the home said, “The cook is fantastic she does home baked cakes every day we are so lucky to have her. “
When we discussed the principles of the MCA and DoLS with the registered manager and staff, they demonstrated a good understanding. The registered manager told us they were in the process of completing multiple DoLS applications.
We found people had access to healthcare professionals and their healthcare needs were met.
The management team completed a variety of assessments, which formulated each person’s care plan and nursing needs if required. Records were personalised to individual needs and reviewed on a regular basis.
People who lived at the home and relatives told us staff had a caring, sensitive and kind attitude. Comments included from a relative, “The staff are always friendly, polite and from what I see kind to residents.”
People who lived at Appleby Grange had information on how to raise a complaint or voice any concerns. Relatives we spoke with and people who lived at the home confirmed this. The complaints procedure was available in the reception area of the home so people and visitors had the information at hand.
Staff updated care plans on a regular basis to check support continued to meet people’s changing needs. The registered manager completed life histories of each person and checked their wishes in relation to, how they preferred to be known as, their interests, religious needs and meals.
The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, relative surveys and staff/resident meetings to seek their views about the service that was provided.