CQC report explained · a nursing home
What the CQC found at Appleby Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed, medicines were managed safely, staffing levels were sufficient and infection control arrangements were in place. They also found improved accident and falls monitoring.
- Effective?
- Good
- Staff training and support had improved. Care plans reflected people's needs, staff worked with health professionals, and people were supported with food, drink and healthcare.
- Caring?
- Good
- This question was not covered by this focused inspection, so the report does not give a new rating for it.
- Responsive?
- Good
- This question was not covered by this focused inspection, so the report does not give a new rating for it.
- Well-led?
- Requires improvement
- Management records and audits had improved, but organisational oversight was not always effective enough to identify and address shortfalls. The provider had plans to strengthen its quality assurance systems.
What inspectors found, October 2020
Rated Good overall; inspectors found safe and effective care, but the home's leadership and quality checks still needed improvement.
This was an unannounced focused inspection on 26 August and 2 September 2020. Inspectors checked whether the home had acted on problems found at the previous inspection. They reviewed care, medicines, staff training and management records, spoke with relatives and staff, and observed people living at the home. They did not speak directly with residents because of the coronavirus pandemic.
The home was rated Good for Safe and Effective. Inspectors found enough staff, safe medicines arrangements, suitable risk assessments and good infection control measures. Staff training had improved, people's care needs were understood, and the home worked well with health professionals.
The home was rated Requires Improvement for Well-led. Audits and records had improved, but the organisation did not always have strong enough oversight to find and deal with shortfalls. The provider was no longer in breach of the three regulations identified at the previous inspection, but inspectors recommended further work on quality assurance.
The overall rating changed from Requires Improvement to Good. This included ratings carried over for key questions that were not examined during this focused inspection.
Sufficient staffing
Inspectors found enough staff in suitable roles. Relatives also praised the stability and quality of the staff team.
“I think [registered manager] is doing great job at keeping a fantastic group of dedicated carers.” from the report
Improved staff training
Essential training had been updated and staff had access to supervision and appraisal. Relatives described staff as competent and knowledgeable.
“The care staff know what they are doing” from the report
Safe infection control
Inspectors were assured that the home had measures to prevent and manage infection, including safe use of protective equipment and testing.
“We were assured that the provider was using PPE effectively and safely.” from the report
Personalised care
Relatives praised the personalised support and said staff treated people as individuals.
“I would say that they do fulfill all my relative's needs, but above all they do look after them as real person.” from the report
Quality oversight
needs fixingThe home had improved its audits, but the provider's oversight was not always strong enough to identify and address problems. Inspectors recommended continued development of the quality assurance systems.
“Some still needed strengthening and there had not always been effective oversight by the organisation to make sure that shortfalls were identified and addressed.” from the report
Medicines competency records
needs fixingStaff were trained to apply prescribed ointments, but their competency in this task had not been recorded.
“Care staff were trained by nurses in applying prescribed ointments. Their competency in this area needed to be recorded and the registered manager said this would be done.” from the report
Clinical skills records
needs fixingThe nurses' training matrix did not yet show their clinical competencies clearly. Management agreed to update it.
“The training matrix included a list of the clinical skills for nurses but this record was largely blank.” from the report
Best-interests records
needs fixingRecords about decisions for people who lacked capacity had improved, but they still needed more detail about the specific areas of care involved.
“These needed some further improvement to set out the specific areas of care involved in best interests decisions.” from the report
- 01What quality assurance improvements have been completed since this inspection, and how are actions now checked and signed off?
- 02How do you record staff competency for applying prescribed ointments and other clinical tasks?
- 03Can you show how best-interests decisions are recorded for each specific area of care?
- 04How has the nurses' clinical skills training matrix been completed and kept up to date?
- 05Which ratings were carried over from the previous comprehensive inspection because Caring and Responsive were not assessed during this visit?
This was a focused inspection of Safe, Effective and Well-led; the other key questions were not looked at and their previous ratings were used in calculating the overall rating. This explanation was written from the published report of 15 October 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, April 2020
Rated Requires Improvement; inspectors found kind and responsive care, but serious gaps in medicines, staff training, consent and management checks.
This was an unannounced inspection on 2 March 2020. Inspectors spoke with people living at the home, relatives, staff and a visiting professional. They observed care, looked around the building and checked care, medicines, recruitment and management records.
People said they felt safe and were treated kindly, with dignity and respect. Staffing levels and recruitment were suitable. The home supported activities, meals, healthcare and communication well. However, some staff lacked training in medicines, infection control, dementia care and other areas needed for people's needs.
Inspectors found medicines errors, incomplete checks after some falls, and weak systems for learning from incidents. Records did not always show that consent and mental capacity had been properly considered. The provider was in breach of Regulations 11, 17 and 18. The overall rating fell from Good at the previous inspection in September 2017 to Requires Improvement.
Kind and respectful care
People spoke positively about staff and said they were treated with dignity, respect and kindness.
“People were supported by caring and respectful staff who treated them with dignity.” from the report
Suitable staffing and recruitment
Inspectors found suitable staffing levels during the visit and safe recruitment checks had been completed.
“The registered manager followed safe staff recruitment procedures.” from the report
Activities and relationships
The home provided meaningful activities and supported people to keep in touch with relatives and visitors.
“People were supported to keep active and improve their mental and physical well-being through meaningful activities.” from the report
Good response to individual needs
Care records contained important information and staff responded to changing needs, including by seeking professional advice.
“Care records were detailed and contained important details about people.” from the report
Medicines safety
seriousNot all staff who handled some medicines had received training or competence checks. Inspectors found medicines errors, including one person not receiving a required dose for 11 days, and audits were not robust.
“We saw medicines errors that demonstrated staff had not always followed best practice guidance to check the right person was receiving the right medicines.” from the report
Staff training and support
seriousTraining was not always provided on time or in areas linked to people's needs. Staff had also not always received effective supervision and appraisals.
“There was a failure to ensure that all staff had received such appropriate support and training as is necessary to enable them to carry out the duties they are employed to perform.” from the report
Consent and mental capacity
seriousRecords did not always show that consent had been sought or that best interest decisions had been considered. People's ability to make specific decisions had not always been assessed.
“There was a failure to ensure people's consent was sought.” from the report
Management checks and learning
seriousThe provider's quality systems did not reliably identify problems or ensure that lessons were learnt from incidents. This included weak medicines audits and no clear analysis of accidents and incidents.
“The governance and quality assurance systems were not robust enough to effectively monitor areas where requirements were not met in a timely manner.” from the report
Infection control training
needs fixingThe home was visibly clean, but not all staff had completed infection prevention and control training. The registered manager was asked to take immediate action.
“Not all staff had received training in the prevention and control of infections.” from the report
Dementia care
needs fixingThe provider had not fully put its dementia strategy into practice, including dementia training and dignity and respect training. Inspectors said this could affect consistent person-centred care.
“People living with dementia would not be assured they would receive consistent dignified and person-centred care from a skilled staff team.” from the report
- 01What changes have been made to ensure every staff member handling creams, thickening powders and other medicines is trained and has passed a competence check?
- 02How do you now check that medicines are given correctly and that lessons are learnt promptly from any error?
- 03How are falls, especially unwitnessed falls or falls involving a head injury, monitored and reviewed?
- 04How do you record people's mental capacity, consent and best interest decisions before care or restrictions are put in place?
- 05What training and supervision have staff now received in dementia care, infection control, equality and diversity, and other areas linked to residents' needs?
This was an unannounced comprehensive inspection covering all five key questions; all five ratings were assessed and the Safe, Effective and Well-led ratings had deteriorated from Good at the previous inspection. This explanation was written from the published report of 10 April 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.
Every inspection of Appleby Grange
3 rated inspections over 3 years: the service has held its Good rating throughout.
- October 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2016
Registered with the Care Quality Commission on 11 August 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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
9 live-in carers within about an hour of Westmorland and Furness
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.
8 can care for a couple. 10 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.