CQC report explained · a residential care home
What the CQC found at Apple Blossom Court
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2020
Rated Requires Improvement; inspectors found kind care and some improvements, but staffing, communal spaces and management still needed attention.
This was an unannounced focused inspection on 3 November 2020. Inspectors looked at whether the home was safe and well-led because concerns had been raised about the quality and safety of care. They spoke with people, relatives and staff, and checked care records, medicines, staff files and management records.
The home was rated Requires Improvement overall. Safe and well-led were also rated Requires Improvement. Inspectors found that there were not always enough staff to meet people's needs, and that the layout and use of communal areas did not suit everyone. Some people became isolated or chose to stay in their bedrooms.
There were also positive findings. Staff were kind and respectful, medicines were administered safely, the home was clean and safety checks were carried out. The registered manager had made some improvements, but the home remained Requires Improvement for the second consecutive inspection.
Kind staff
Staff were respectful and knew people's day-to-day preferences. People appeared comfortable with them.
“Staff were kind and respectful in their approach towards people and were knowledgeable about their day to day preferences.” from the report
Medicines
Medicines were administered safely by trained staff. Records of medicines given and stocks held were accurate and regularly checked.
“People's medication was administered safely by trained staff members.” from the report
Cleanliness and infection control
The home was clean and had supplies of personal protective equipment. The manager had COVID-19 risk assessments, guidance and regular hand hygiene checks in place.
“The home was clean. Since our previous inspection the provider had employed dedicated domestic staff to help ensure cleaning and laundry duties were completed.” from the report
Management improvements
The registered manager had introduced audits and some improvements and refurbishments. Families and staff spoke positively about the changes and communication had improved.
“There had been a series of improvements at the home under the registered manager.” from the report
Staffing levels
seriousThere were not enough staff at some times to meet people's support needs and complete necessary tasks. Cooking meals also took care staff away from supporting people, although a cook was recruited after the visit.
“There were not enough staff available to meet people's identified support needs and complete necessary tasks.” from the report
Communal areas and choice
needs fixingThe main lounge was cramped, lacked natural light and did not have enough seating. Noise, activity and competing needs meant some people had negative experiences, became isolated or stayed in their bedrooms.
“Some people's needs, choices and preferences did not fit in with or clashed with others when using the communal areas of the home.” from the report
Clinical waste storage
needs fixingPPE and clinical waste were not always stored appropriately. Some outside bins were missing lids or had ill-fitting lids, and bins did not always allow staff to avoid touching them.
“PPE and other clinical waste were not always being stored appropriately.” from the report
Information for PRN medicines
needs fixingMedicine records did not explain why as-needed medicines had been prescribed, when they should be used or what support people needed. Some of this information was held elsewhere in care files.
“People's medication records did not contain information for staff regarding the reason PRN medication had been prescribed, when the use of PRN medication is appropriate and what support people need.” from the report
- 01What staffing levels are now planned for each shift, and how will you make sure people's identified support needs are met?
- 02What has changed in the main lounge and other communal areas to reduce noise, crowding and conflict between people's needs?
- 03How are people's one-to-one support hours planned and checked to make sure they are used effectively?
- 04How are PRN medicine records now being updated to explain when medicines should be used and what support each person needs?
- 05What action has been completed to store PPE and clinical waste safely?
This was a focused inspection of Safe and Well-led only; the other question ratings were not inspected and previous ratings were used to calculate the overall rating. This explanation was written from the published report of 19 December 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2019
Rated Requires Improvement; inspectors found kind, person-centred support, but concerns remained about safety checks, records, confidentiality and leadership.
This was an unannounced inspection on 17 and 20 September 2019. CQC reviewed care and medicine records, staff recruitment and training files, management records, and the home itself. They spoke with people, a relative, staff and health professionals.
The home was clean and people appeared to have warm relationships with staff. People had choice, support to be independent, detailed care plans and accessible ways to complain or communicate. The Responsive rating was Good.
However, some safety checks were out of date, controlled medicines were not stored securely, and important information was not always added to care plans. The inspection also found a confidentiality problem, weaknesses in staff induction and recruitment records, and quality systems that had not found these issues. The overall rating remained Requires Improvement.
Kind relationships
Inspectors saw staff supporting people calmly and respectfully. People said staff were kind and caring.
“People told us that they liked the staff and found them to be kind and caring” from the report
Choice and independence
People were supported to make decisions, go out when they wanted and develop their independence. Staff used the least restrictive approach and followed mental capacity processes.
“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” from the report
Personalised support
Care plans recorded people's routines, preferences and communication methods. Staff showed a good understanding of the people they supported.
“Support plans contained some specific, individual information, about the person.” from the report
Good response to people's needs
The home had accessible information and complaints procedures. Staff supported people's relationships, activities and access to health care.
“We saw how the provider made sure information was available in different ways for the benefit of the people living in the home.” from the report
Medicine storage
seriousControlled medicines were not stored securely in line with best practice. The manager was told about this during the inspection.
“however the controlled medicines were not appropriately secured.” from the report
Out-of-date safety checks
seriousExternal checks for electricity, gas and fire safety were out of date. Audits also failed to identify known problems such as fire doors not shutting properly.
“Appropriate checks by external bodies for electric, gas and the fire risk assessment were out of date.” from the report
Care records not kept up to date
needs fixingInformation in daily notes and accident forms was not always transferred into care plans and risk assessments. This could leave staff without current guidance about people's needs.
“Risk assessments did not always reflect the changing needs of the people living in the home.” from the report
Confidentiality and dignity
seriousInspectors found a confidentiality breach. They questioned whether staff understood what respectful treatment required.
“During the inspection we identified a breach of confidentiality that was not respectful of people living in the home.” from the report
Staff induction and recruitment records
needs fixingThe induction did not cover all subjects set out in the provider's policies. Some recruitment files did not contain appropriate references.
“The induction the provider had in place was not sufficient to introduce new staff into the service.” from the report
Weak quality oversight
needs fixingThe home's audits had not identified several problems found by CQC. The provider had also not supplied requested information about recruitment and support for the new manager.
“Whilst there were systems in place to assess and monitor the quality and safety of the service, these were not being fully effective.” from the report
- 01How are controlled medicines now secured, and when was this change checked?
- 02Have all fire, gas and electrical safety checks been brought up to date, including checks that fire doors close properly?
- 03How do you make sure information from daily notes and accident forms is added promptly to care plans and risk assessments?
- 04What has changed in staff induction, recruitment references and training for supporting people with learning disabilities?
- 05How are quality audits now checking confidentiality, cleaning, safety and care records so that problems are found promptly?
This was an unannounced inspection prompted by concerns about recruitment, infection control and staffing, and it reviewed all five key questions, with the previous ratings used as a comparison. This explanation was written from the published report of 1 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Apple Blossom Court
4 rated inspections over 3 years: the service has held its Requires improvement rating throughout.
- December 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- March 2019Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2018Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2016
Registered with the Care Quality Commission on 21 October 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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40 live-in carers within about an hour of Wirral
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,230 a week. 37 can care for a couple. 8 years' experience on average.
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
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