CQC report explained · a nursing home
What the CQC found at Appletrees Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, April 2023
Bluebrooke Nursing & Residential Care Home was rated Requires Improvement; inspectors found risks in care records, medicines, dignity and quality checks.
This was an unannounced inspection over two days. Inspectors spoke with people, relatives and staff. They reviewed care plans, medicine records, training, recruitment records, audits and safety checks.
The home was not consistently safe. Risks were not always identified or managed. Medicine records were incomplete, recruitment checks were missing information, and some infection control practices needed improvement. These issues increased the risk of harm.
People's needs were not always fully assessed or reflected in their care plans. Mealtimes, activities, communication support and involvement in care planning were inconsistent. Inspectors also saw some care that did not fully protect people's dignity or respect their choices.
The overall rating and all five question ratings were Requires Improvement. The provider breached Regulation 12 on safe care and treatment and Regulation 17 on good governance. The home was asked to make improvements and CQC will monitor progress.
Partnership working
The home worked with doctors, nurses, dieticians and specialist nurses. Staff also supported people to attend hospital appointments.
“The home worked in conjunction with other agencies to meet the needs of people living at the home.” from the report
Choice and legal safeguards
Inspectors found that the home was working within the principles of the Mental Capacity Act. Best interest decisions and relevant restrictions were reviewed regularly.
“The home was working within the principles of the MCA.” from the report
Accessible environment
The building had adapted bathrooms, accessible spaces and quiet areas. People's bedrooms were personalised with their belongings.
“People lived in an environment that was accessible and met their needs.” from the report
Complaints process
The complaints process allowed concerns to be investigated in a timely way. The one complaint recorded in the previous year had been resolved.
“The home had an effective complaints process in place which allowed the registered manager to investigate concerns in a timely manner.” from the report
Some kind care
Inspectors saw warm interactions, and end of life care was provided with kindness and compassion in the cases they reviewed.
“Where people were being supported with their end of life care needs we saw this was done with kindness and compassion by staff.” from the report
Risks and care records
seriousRisk assessments did not always identify people's needs. Daily records did not consistently show that planned support, such as repositioning, fluid monitoring and personal care, had been provided.
“Systems were not sufficiently robust to assess, monitor and mitigate risks to the health, safety and welfare of people using the service” from the report
Medicine records
seriousSome people did not have clear instructions for medicines given when needed. Staff did not always record when prescribed creams had been applied.
“The proper and safe management of medicines was not consistently demonstrated. This placed people at risk of harm.” from the report
Dignity and choice
needs fixingPeople were not always supported to use cutlery or change soiled aprons. Inspectors also saw a person's choice about wearing an apron being ignored and staff not responding to repeated requests for interaction.
“People could not be assured they would always be treated with dignity and respect.” from the report
Activities and involvement
needs fixingThe home had not asked people what activities they wanted, and scheduled activities were not taking place during the inspection. Regular residents' meetings and family involvement in care plan reviews had not restarted.
“People were not supported in activities and hobbies that met their needs.” from the report
Quality checks
seriousAudits and daily checks did not identify problems that inspectors found, including gaps in care records. This limited the home's ability to learn and improve.
“The provider failed to ensure systems and processes were in place to assess, monitor and improve the service.” from the report
- 01What has been done to make sure risk assessments identify changes in people's needs and that daily care records match their care plans?
- 02How are prescribed creams and medicines given when needed now recorded and checked?
- 03What recruitment checks are completed before new staff and agency staff work with residents?
- 04What activities are now taking place, and how have residents' views been used to choose them?
- 05How are families and residents now involved in care plan reviews and end of life decisions?
This was an unannounced first inspection of the newly registered service and covered all five CQC key questions, including care and the premises. This explanation was written from the published report of 21 April 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, February 2022
Bluebrooke Nursing & Residential Care Home was inspected but not rated; inspectors were assured about infection prevention and control.
This was a targeted inspection on 27 January 2022. It was announced one day beforehand and focused on infection prevention and control during COVID-19, as well as staffing pressures.
Inspectors found good practice in helping people keep in touch with family and friends. Visiting arrangements supported important family events and visits at the end of life. People were also supported to use parts of the home safely during isolation, with as few restrictions as possible.
The home was following visiting, testing, vaccination, personal protective equipment, cleaning and ventilation measures. The service was inspected but not rated, so this report does not give a Good, Requires improvement or Inadequate rating.
Family contact
People were supported to keep in touch with important people in their lives using telephone calls and online technology. Staff considered how each person preferred to communicate.
“People were encouraged to continue maintaining relationships with others who were important to them, with support from staff.” from the report
Visiting arrangements
The home kept visiting arrangements in place, including for important family events and when people were nearing the end of their lives.
“Visiting arrangements were consistently in place to provide comfort to people at the end of their lives.” from the report
Infection control
Inspectors were assured about the home's arrangements for PPE, testing, cleaning, ventilation, visiting and managing outbreaks.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Clear staff guidance
The registered manager had explained what staff should do if infections occurred. This helped guide staff practice and reduce the chance of infections continuing for a long time.
“The registered manager had clearly communicated their expectations to staff in the event of any infections.” from the report
Refurbishment and equipment
minorA refurbishment programme had started, and senior staff were still identifying equipment that might need replacing. Families may wish to check what work and replacements have since been completed.
“Senior staff were in the process of identifying any equipment which may require replacing, to further promote good infection control.” from the report
- 01What changes have been made since the inspection to the refurbishment and to equipment identified for replacement?
- 02How do you currently manage visiting during an infection outbreak, including visits at the end of life?
- 03How do you manage staffing pressures when COVID-19 or other illness affects staff availability?
- 04How are residents supported to keep in touch with family and friends if they cannot meet in person?
- 05What current arrangements are in place for testing, PPE, cleaning and ventilation?
This was a targeted inspection of infection prevention and control and COVID-19-related staffing pressures; it was not a full inspection and the service was not rated. This explanation was written from the published report of 3 February 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 Appletrees Care Home
Each visit the CQC has published, newest first, back to the day the home was registered.
- April 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2022Inspected but not ratedSafe: Inspected but not rated
- October 2021
Registered with the Care Quality Commission on 28 October 2021.
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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