About the service: Appleby is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Appleby House is owned and operated by Care UK Community Partnerships Ltd. It provides accommodation and nursing care for up to 75 older people who are living with dementia. There were 66 people living in the service at the time of our visit. The service is arranged into five individual units, referred to as ‘suites’ throughout this report.

People’s experience of using this service: Without exception people praised the quality of support provided at Appleby House and we were repeatedly told they “Couldn’t wish for anything better.” Without hesitation, people and their representatives said they would recommend the service to others.

Appleby House had an excellent reputation within the local community and was widely recognised for the high-quality dementia care provided. The registered manager had been awarded ‘Registered Manager of the Year’ for 2018.

People and staff identified themselves as being part of the ‘Appleby Family’ and the warmth and strength of bonds across the service was evident from the moment of arrival. The service had embraced recognised dementia best practice models and as such the physical environment provided people with a vibrant and specialist space to live.

People received exceptional care in a way that was personalised and responsive to their changing needs. A high ratio of staff meant people never had to wait long for assistance and there was also someone around to help them or chat with. People had confidence in the staff who supported them and felt safe in their care.

Staff were well trained and skilled at supporting people living with dementia to lead independent, active and fulfilling lives. People had numerous opportunities to participate in new activities and were encouraged to share and continue with existing hobbies.

Staff worked in partnership with community health professionals and therapists to maximise people’s well-being and wherever possible, improve their health. People enjoyed a wide range of nutritionally balanced meals and specialist diets and preferences were catered for.

People benefitted from living in a well organised, forward thinking home where their needs were always put first. The culture of the home was open, and people felt confident to express their views and opinions.

Rating at last inspection: Good (Published August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We service has improved from Good to Outstanding.

Follow up: We will continue to monitor intelligence we receive about the service until we visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 26 July 2016 and was unannounced. At the last inspection of Appleby House in June 2013 we found the service was meeting the regulations we looked at.

Appleby House provides accommodation and personal care for up to 75 older people. The service specialises in caring for people living with dementia. At the time of our inspection there were 52 people living at the home.

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

People were supported to live an active and fulfilling life at Appleby House. Staff encouraged and supported people to participate in a wide range of activities both in the home and community to promote social inclusivity. This was achieved by using various initiatives designed to promote positive wellbeing in older people, particularly for people living with dementia. Staff were trained to use positive communication techniques to encourage people to interact and participate as much as they could and wished to. The wide range of activities offered at the home had helped to improve people’s overall health and wellbeing.

People said they were safe at the home. People using the service were living with dementia and staff were aware of the risks posed to their health, safety and wellbeing. Appropriate plans were in place to guide staff in how to minimise these risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse. They were encouraged to raise and report any concerns they had about people through well-established safeguarding and whistleblowing procedures.

People said Appleby House was a comfortable place to live. Thought and attention had been given to the layout and design of the home to help people orientate and move freely around. Staff kept the home free from obstacles and trip hazards so people could move around safely. The premises and equipment was checked and maintained to ensure it was safe. There were enough staff to support people in the home and to meet their needs. The provider had carried out appropriate checks to ensure staff were suitable and fit to support people.

Staff received appropriate training and support. They had a good understanding of people’s needs and how these should be met. People and relatives said staff looked after people in a way which was kind, caring and respectful. Staff knew how to ensure that people received care and support in a dignified, respectful way and which maintained their privacy at all times. Staff supported people, where appropriate, to retain as much independence as possible, when carrying out activities and tasks.

Staff encouraged people to stay healthy and well. People were supported to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. Staff regularly monitored people’s general health and wellbeing. Where there were any issues or concerns about a person’s health, they ensured they received prompt care and attention from appropriate healthcare professionals such as the GP. People received their medicines as prescribed and these were stored safely in the home.

People were involved in planning and making decisions about their care and support needs. Care plans were in place which reflected people’s needs and their individual choices and preferences for how they received care. We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and t

We visited Appleby House to look at the care and welfare of people who used the service. We spoke with five people who used the service and four family members. As we were unable to verbally communicate with some people we spent time observing the interactions between the people and staff. We observed these to be positive.

People told us they liked living in the home. Some people told us “This was not a home but their house and everyone was very nice. One person discussed in depth their medical problems and told us “The doctor will be able to sort me out I know I’ll be ok.”

We saw that staff spoke with people who used the service and their relatives. This was to ensure they gained consent prior to personal care or treatments being carried out.

We observed lunchtime in one unit. We saw people who used the service enjoying lunch. Staff supported those that required help with their meal. Choices were offered for main course and dessert.

Safeguarding training had taken place for staff and they had good knowledge of the procedures to be followed.

The provider carried out appropriate checks to ensure staff were of good character and had the necessary skills and experience before they were employed.

The provider had systems in place which ensured complaints were listened to and taken seriously.

People using the service were not able to give us feed back so we used a range of alternative methods to gather this information, including observations and discussions with staff.

We observed that a variety of activities were taking place in the units including a quiz, staff talking with people who used the service and assisting them with an activity for example a jigsaw.

People using the service were not able to give us feed back so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed for 45 minutes in one of the home’s larger units, and observed for an hour during the lunch service in another unit.

We observed good interactions between staff and people who used the service during the inspection. Staff addressed people using their preferred name as documented in their care plans.

We did observe that staff were very busy and the morning medicine round took until 11:20 to complete. We also observed that there were not enough staff available during the lunch time meal service in one particular unit that we visited.