This inspection took place on 7, 8 and 14 January 2016. Our visit on the 7 January was unannounced.The service was last inspected on 5 August 2014 when no breaches of regulations were found.
Appleton Manor Nursing Home is a nursing home managed by HC-One. It provides 24 hour nursing care and support for up to 58 older people including people with dementia. It is situated on the borders of Brinnington and Bredbury near Stockport. It is close to local amenities and there is convenient access to public transport and motorway networks. The home is a modern two storey building; people with nursing needs are accommodated on the ground floor, with a residential unit upstairs accommodating up to 33 people. On the day of our inspection there were 54 people accommodated.
When we visited the service a registered manager was not in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 of the home had recently been appointed, but not yet registered with CQC, and was present throughout. The previous registered manager, who had moved to become a peripatetic manager for HC-One homes was also present during our inspection. The appointment of the new manager had been well received. One visitor told us “We are seeing lots of improvements. She’s got the passion for it
We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
Not all care plans were written in a person centred way and this could place people at risk of receiving unsafe or inappropriate care.
There was a strong offensive odour that permeated throughout the first floor of the home originating from a person’s bedroom. Although there was an appropriate cleaning schedule this had not helped to remove these odours.
People who used the service had risk assessments relating to their health and safety on their care files, but these had not always been fully completed and reviewed regularly to make sure the identified risks were mitigated.
Care plans contained out of date information and rooms did not display people’s names which increased the risk being of people being given the wrong care and treatment.
Care plan reviews did not take into account specific issues which could result in poor outcomes for people, such as skin integrity needs, continence support needs and dementia needs.
Staff we spoke with were confident about their duties and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and had received training in this topic.
People who used the service, who we asked, told us that Appleton Manor was a safe place to live and felt they were well looked after. People we saw looked well cared for and comfortable in their surroundings. We had brought our inspection forward following concerns raised with us about recruitment and retention of staff and safeguarding issues. When we inspected we saw that where allegations of abuse and issues of concern had been brought to the attention of the provider action had been taken to minimise the effect on people who used the service. Staff shortages led to an over reliance on agency staff, and the home had halted new admissions into the home until staff could be recruited and given appropriate training. When we spoke to the home manager about this, she informed us that nine new starters had been recruited to commence training the week following our visit.
Staff understood their role in making sure they safeguarded vulnerable people from harm and had undertaken training in adult safeguarding.
The staff training records showed staff had access to a range of appropriate training such as dementia awareness, pressure care awareness and end of life care and the staff we spoke with confirmed this. They also told us that they felt well supported by the new manager and found the management team very approachable.
Staff had all received a thorough induction, training and support when they started work at Appleton Manor and understood their roles and responsibilities in relation to the care and support people required.
People were supported by sufficient numbers of suitably trained staff, who had been appropriately and safely recruited to support and meet people’s individual needs.
People were provided with personalised care by staff who supported them to live as independently as possible. People were also supported by staff to eat and drink enough to maintain a balanced diet. We found that people’s care was delivered consistently by staff who knew how to support people and meet their assessed care needs.
We saw good relationships between individual staff and people who used the service. We saw that care was provided with kindness; staff were respectful when speaking with people and responded promptly when people required assistance.
People told us they knew who to speak to if they wanted to raise a concern or complaint and a copy of the complaints process was displayed in prominent areas throughout the home.
Systems had been put in place to monitor the quality of service being provided. These systems included regular checks on all aspects of the management of the service.