CQC report explained · a nursing home
What the CQC found at Appleby Court Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People's safety had improved, with better risk assessments, care records, infection control and safeguarding. Inspectors found two handwritten medicine records that had not been signed and checked, and said recent improvements needed to be sustained.
- Effective?
- Good
- This question was not inspected in this report. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This question was not inspected in this report. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected in this report. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- Management oversight, audits, records and partnership working had improved. Inspectors said there was limited evidence that these recent improvements would be sustained.
What inspectors found, May 2023
Appleby Court Care Home is rated Requires Improvement; it has left special measures after important improvements, but these need to be sustained.
This was a focused inspection on 26 April and 3 May 2023. Inspectors checked Safe and Well-led. They spoke with people, relatives, staff and managers, and reviewed care, medicine and management records.
The home had improved since the previous inspection. Risk assessments, care plans, safety checks, infection control, safeguarding and staffing were better. Medicines were generally managed safely, although two handwritten medicine records were not signed and checked as required.
Management systems and records had improved. However, these changes were recent, so inspectors could not yet be sure they would last. The overall rating improved from Inadequate to Requires Improvement, and the home is no longer in special measures.
Better risk management
Risk assessments and care records were more detailed and gave staff clearer guidance. Staff used an electronic system to record care and identify new risks quickly.
“Risks to people's health, safety and welfare were assessed, monitored, and managed using improved processes and systems.” from the report
Infection control
Inspectors were assured that protective equipment was used safely and that the home was managing a COVID-19 outbreak effectively. The environment was kept clean and hygienic.
“The cleanliness and hygiene of the environment was maintained to a high standard.” from the report
Enough staff
Inspectors found enough suitably skilled staff to meet people's needs. Staff were visible and responded promptly to calls for help.
“There were enough staff on duty with the right qualifications, competence, and skills to meet people's needs and keep them safe.” from the report
Safeguarding
Managers and nurses understood how to identify and report abuse. Safeguarding referrals were made promptly and people said they felt safe.
“People told us they felt safe, and that staff treated them well.” from the report
Improved oversight
The provider had introduced audits, action plans and monthly meetings to monitor the home's quality and safety. Records were more accurate and up to date.
“There was improved oversight of the service on behalf of the provider.” from the report
Improvements not yet established
needs fixingThe new systems had only recently been introduced. Inspectors could not yet see enough evidence that the improvements would continue over time.
“There was limited evidence to show sustainability as the improvements had only recently been made.” from the report
Medicine record checks
needs fixingTwo handwritten medicine records had not been signed by the person who wrote them or checked by a second staff member. The manager said this would be followed up.
“However, there were two examples where handwritten information had not been signed by either the scriber or checked by a second member of staff in line with best practice guidance.” from the report
Registered manager application pending
minorThere was no registered manager in post during the inspection. A manager had applied to CQC to become the registered manager.
“At the time of our inspection there was no registered manager in post.” from the report
- 01How have you kept the new electronic care plans and risk assessments accurate and up to date since the inspection?
- 02What checks are now in place to make sure every handwritten medicine record is signed and checked by a second person?
- 03Has all remaining safeguarding training for care and ancillary staff now been completed?
- 04What evidence can you show that the improvements have been sustained over time?
- 05Has the manager's application to become the registered manager been completed?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 18 May 2023 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, October 2022
Rated Inadequate and placed in special measures; inspectors found serious ongoing problems with safety, records, medicines and management.
This was an unannounced focused inspection on 8 and 13 September 2022. Inspectors reviewed the Safe and Well-led areas because of concerns about safety, governance and leadership. They spoke with people, relatives, staff and managers, and checked care, medicine, recruitment and management records.
People were at risk because care records did not reliably explain their needs or the risks they faced. Medicines were not always stored securely or recorded accurately. Training records were incomplete, infection control guidance was not followed at first, and accident records did not show clearly what action had been taken.
Management systems were not effective. Audits failed to identify problems, improvements had not been made since the previous inspection, and there was no registered manager in post. The home remained in breach of Regulations 12 and 17.
The overall rating fell from Requires Improvement to Inadequate. The inspection only assessed Safe and Well-led. The other key question ratings were carried over from the previous inspection.
Staffing levels
Inspectors found enough staff were deployed to meet people's needs. Agency staff were used when needed.
“There was the right amount of suitably qualified staff deployed across the service to meet people's needs and keep them safe.” from the report
Recruitment checks
The required checks were completed for a newly employed staff member and agency staff.
“Safe recruitment processes were followed. The required checks were carried out on applicants and agency staff to make sure they were fit and suitable for the role.” from the report
People felt safe
People told inspectors they felt safe and were treated well. Relatives said they were confident their family member was kept safe.
“People told us they felt safe and were treated well by staff.” from the report
Clean environment
The environment was clean and high-touch areas were cleaned regularly.
“The cleanliness and hygiene of the environment was maintained to a good standard. Regular cleaning of high touch areas was taking place.” from the report
Incomplete risk information
seriousCare plans and risk assessments did not consistently explain people's needs or how to reduce risks. Some records had not been updated after changes in people's health or care.
“Records continued to lack information about people's needs to minimise the risk of harm to them.” from the report
Medicines not secure
seriousThe ground-floor medicines room and controlled-drug cabinet were unlocked. Handwritten medicine records were not checked properly, and some temperature records were missing.
“The medication room on the ground floor was unlocked and the cabinet containing controlled drugs (CDs) within the room was also unlocked.” from the report
Staff training gaps
seriousTraining records did not show that staff had up-to-date training in areas including infection control, first aid, diabetes, catheter care and safeguarding.
“Just four staff out of 47 had received up to date safeguarding training.” from the report
Weak management checks
seriousAudits and checks did not identify problems found by inspectors. The provider had made very little progress since the previous inspection.
“There had been very little progress made to improve the quality and safety of the service since our last inspection.” from the report
Face masks not used
seriousStaff had not been wearing face masks in line with the guidance at the start of the inspection. They were told to wear them after inspectors raised the issue.
“On the first day of inspection staff were not wearing face masks and we were advised they had not worn them for two days prior to our inspection.” from the report
- 01What has been done to update care plans and risk assessments, including those about breathing, diabetes, skin care, weight and continence?
- 02How are medicines, controlled drugs, handwritten MARs and medicine-room temperatures now checked and recorded?
- 03How many staff now have up-to-date training in safeguarding, infection control, first aid, diabetes and catheter care?
- 04Who is currently responsible for managing the home, and what progress has been made towards having a registered manager?
- 05What evidence can you show that audits now identify problems and that action is followed up?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried over from the previous inspection. This explanation was written from the published report of 14 October 2022 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 Appleby Court Care Home
5 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- May 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2022Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- February 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
- July 2021Inspected but not ratedSafe: Inspected but not rated
- March 2019Goodstayed GoodSafe: GoodWell-led: Good
- July 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 28 January 2011.
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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