This inspection was unannounced and took place on 23 January and 1 February 2019.

Appleby Court is a care home registered for 60 residents. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Appleby court is ten minutes away from the town of Kirkby. There are fifty-eight single rooms, two double rooms and twenty one rooms providing en-suite facilities. There is communal space on each floor. At the time of our inspection there were 51 people living at the home.

The home had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated good.

The registered provider continued to have safe recruitment processes in place. All staff had completed an induction and undertook training relevant for their roles. Regular refresher update training was also undertaken in accordance with good practice guidelines. Staff received regular and consistent support through supervision and team meetings.

Staff had all undertaken safeguarding training and felt confident about what they would need to do if they had any concerns about the people they supported. The registered provider had safeguarding policies and procedures in place that staff understood where to find.

People had their needs assessed prior to moving into the home and this information was used to create person centred care plans and risk assessments. Documents included clear guidance for staff to follow to fully meet people’s individual needs. People’s needs in relation to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. All care plans were reviewed and updated regularly.

People told us they had developed positive relationships with the staff who supported them. We observed positive interactions between people and staff throughout our inspection. Staff were kind and caring and respected people’s privacy and dignity. A variety of activities were available for people to participate in.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. Medicine administration records (MARs) fully completed and regularly audited for accuracy. Staff who administered medicines had all received training and had their competency assessed.

People’s care plans included information about their food and drink needs. Clear guidance was in place for staff to follow when people required specialist diets or assistance.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken basic training and demonstrated an understanding of this. The registered provider had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

Appleby Court was well maintained and all equipment was regularly serviced. Health and safety checks were regularly and consistently undertaken at the home. Fire safety checks were clearly documented. Improvements were planned at the home to more fully meet the needs of the people living there.

The registered provider undertook regular audits at the home. Areas for development and improvement were identified and addressed. Accidents and incidents were analysed to identify trends and patterns within the home. Fire safety checks, health and safety check

This inspection was carried out over two days on 27 & 31 May 2016. The first day of the inspection was unannounced.

Appleby Court Care Home is registered to provide accommodation for persons who require personal and nursing care. The service provides both long term and intermediate care for up to 60 people. Bedrooms are located on the ground and first floor of the building and each floor has two communal lounges, a dining room, bathrooms and toilets. There were 58 people using the service at the time of this inspection.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. A registered manager is a person who has registered with the Care Quality Commission 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 last inspection of the service was carried out in May 2014 and we found that the service was meeting all the regulations that were assessed.

We have made a recommendation about the deployment of staff. Staffing levels had been calculated in accordance with people’s needs and the correct number of staff were on duty. However, there were occasions during our inspection when people who were at risk of falls were left unsupervised for long periods of time, therefore putting their safety at risk.

People told us they felt safe and that they had no concerns about how they were treated. Staff understood their responsibilities for keeping people safe and they knew what to do if they had any concerns about people’s health, safety or wellbeing. Staff knew how to respond to medical and non-medical emergencies and they had access to emergency equipment.

People told us they had received their medication at the right times. Medication was stored, administered and disposed of in a safe way by staff who had received appropriate training. Each person had a medication administration record (MAR) which detailed each item of their prescribed medication, instructions for use and the records were completed correctly.

People received the care and support they needed with their healthcare needs. They attended appointments as required with their GP and other health care professionals involved in their care. A multi-disciplinary approach ensured people’s care was appropriately planned for and reviewed.

People told us they liked the food they were offered and that they were given plenty to eat and drink. Staff were knowledgeable about the support people needed with eating and drinking. People’s dietary needs were also met including required food textures, likes and dislikes.

Staff received training and support which they needed. Training relevant to people’s needs was provided to staff on an ongoing basis and their competency was checked to make sure they understood and benefited from the training undertaken. Regular staff meetings and one to one supervision sessions enabled staff to explore their training needs and discuss any additional support they needed.

People were treated with kindness and their privacy, dignity and independence was promoted. Staff recognised when people were upset and they used techniques to calm people, with good outcomes for them. People’s religion was respected and they were supported to practice their faith, this included attending church services both at Appleby Court and in the local community. People at end of life were cared for in a dignified way and their wishes and preferences at end of life were fully respected.

People and family members had been provided with information about how to complain and they were confident that any complaints they raised would be listened to and dealt with.

The service was well managed by a person who was described as approachable and supportive. People, family members and staff said they were not afraid to approach

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found –

Is the service safe?

Staff had received training in topics relating to health and safety and they were confident about dealing with an emergency situation. Risks to people's health, safety and wellbeing had been identified and acted upon to ensure people received safe care and support. Staff knew what their responsibilities were for safeguarding people and people told us they felt safe living at the home. There was the right amount of skilled and experienced staff working at the home to safely meet people’s needs. Regular checks were carried out at the home to ensure people were safe.

Is the service effective?

Staff had all the information they needed to meet people’s needs and they ensured people received the right care and support. Staff were respectful and polite towards people who used the service and they involved people in their care and the day to day running of the home. People’s preferences and choices were understood and respected.

Is the service caring?

People who used the service and their relatives told us that staff were kind, polite and caring towards them. Relatives' comments included, "It is like one big happy family." Staff spent time with people and respected their wishes. People's religious and lifestyle choices were understood and respected.

Is the service responsive?

People were given opportunities to put forward their views and opinions about the home and the way it was run. Any ideas people had for improvement were listened to and acted upon. People’s requests for assistance were responded to in a timely way and people told us they had never had to wait too long for staff to help them. People were communicated with in a way they could understand.

Is the service well-led?

People were happy with the care and support they received and they felt able to approach the manager and staff with any concerns they had and were confident that they would be listened to.

During our inspection, we spoke to people using services and several family members who confirmed they had been involved in the planning of the person`s care and treatment. Ongoing monthly assessments formed part of the person`s care plan which ensured that wherever possible, people were allowed and encouraged to make their own decisions. The care plans we looked at were up to date and contained clear and relevant information related to the person using services and furthermore, they were reviewed on a monthly basis. During our visit, we observed staff members undertaking good infection control procedures when working around the home, whether in the laundry, kitchen or when domestic duties were being carried out.

We found that people using services at Appleby Court were cared for by staff members who were fit and appropriately qualified for the job. All relevant checks were made by the provider before any employee was allowed to commence work. People were made aware of the complaints system and it was provided in a format that met their needs. If necessary, people were given support by the provider to make a comment or complaint where they needed assistance.

During our inspection we spoke with two people who lived at the home and three people who worked there. We invited them to share with us their views and experiences of the care being provided.

We were able to make general observations within the home during our inspection. We observed staff had a positive rapport with the people who lived there, showing genuine support, warmth and respect.

During our discussions with staff they told us that they were happy within their roles and felt supported by the management and their peers. They told us that training and development was encouraged.

The service had robust quality audit and monitoring systems in place to support the care provided.

We did not receive any direct comments in respect of care planning from the people who live at Appleby Court.

We spoke with individuals who live at Appleby Court and one relative who was visiting. People stated that they felt that the staff team were good and kind and that the care was good. People felt involved in the care they were provided with and had formed strong relationships with the staff. Individuals considered that they felt respected and were able to have their privacy when they wanted.

We received information from a relative. Comments included:

‘No concerns, visiting my aunt was a delightful experience, She was obviously being well looked after, the staff answered the front door immediately, were friendly and welcoming. She was able to move freely in the home, the environment was clean and well decorated and cared for. She was positive about how she was being cared for. Other visitors there were happy.

I wish all homes were of this calibre. I have two other relatives in homes at the moment and none come up to this standard - I am a registered nurse and felt very secure in her care, and was confidently able to report back to other relatives in the south who are not so able to get up north to visit.’