The inspection was unannounced and took place on 7 and 13 August 2018.

Applecroft Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Applecroft is registered to provide accommodation with personal care for up to 23 people. The accommodation is located over three floors. On the day of our inspection there were 18 people living in the home.

This is the fourth consecutive time the service has been rated requires improvement overall.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions: safe, responsive and well led to at least good. We found that they were in breach of the regulations in relation to good governance.

At this inspection, we found that there had been little improvement in the overall leadership and documentation within the service, however the responsive domain had improved to good, but the service remained requires improvement in safe; well led and overall. We found a continued breach of the regulations in relation to good governance. You can see what action we have taken at the back of this report.

Applecroft has no registered manager in post. The current manager has applied to be the registered manager with the Care Quality Commission (CQC). 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 registered provider did not have effective systems in place to assess and monitor the quality and safety of the service. Some of the issues which were identified as part of this inspection, had not been picked up by provider’s audits. Where shortfalls or actions were agreed, the manager was unable to provide documentation to show what progress or actions had been taken to address these shortfalls.

Staff recruitment was safe, however we saw where concerns had been raised about staff conduct, systems had not been followed to address these concerns.

Staff had completed safeguarding training and safeguarding incidents were appropriately referred to the local safeguarding team. However, we saw where recommendations or actions had been agreed following incidents, these had not always been followed up so learning opportunities on how things may be improved or prevented in the future had been missed.

Medication was being stored and administered safely. Regular medication audits were being conducted, however the issues that we identified during our inspection were not picked up by these audits. The provider had policies in place in relation to medication documentation, which were not being followed and this had not been picked up within the audits.

Staff were aware of risks to people and these were managed safely and advice taken from other professionals when necessary. However, documentation around risks was not always in place or detailed.

There were sufficient staff to meet the needs of the people living in the home and they were recruited safely.

Care plans did reflect people’s life history and their needs. We found that some care plans could be more person centred, which had been identified by the manager. People and their relatives told us that the care they received was responsive to their needs.

People and their relatives felt confident that issues that they raised would be addressed. Complaints were recorded and dealt with in accordance with the provider’s complaints policy.

People and their relatives were positive about the staff working in the home as well as the care that they received whilst living ther

The inspection was unannounced and took place on 5 and 10 July 2017.

Applecroft is a privately owned care home located near to Congleton town centre and close to local shops. It is a three-storey building and people can be accommodated on all floors. Access between floors is via a passenger lift or stairs. There are 22 single bedrooms in the home; 16 of them have en-suite facilities.

The service was last inspected in December 2016 when we found three breaches in the regulations. The provider was in breach of the regulations in relation to consent as the provider was not acting within the principles of the Mental Capacity Act 2005. They were also in breach of the regulations around quality assurance as the systems in place were not robustly identifying shortfalls in the service. Furthermore the registered manager had not submitted the required notifications to CQC.

The home has a registered manager. 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. At the time of our inspection there were 18 people living in the home.

We found that overall there had been improvements in the service and systems had been put in place, however we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

We found that whilst there were general risk assessments in place, they were not always detailed and regularly updated. We found that staff were aware of the potential risks and appropriate advice had been sought for people living in the home, however the records were not always reflective of this.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’. However we found where there were changes or additional advice had been sought from other professionals, although staff were aware of and following the advice; the care plans had not always been updated to reflect the changes.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. We saw that whilst the audits had improved since our last inspection, they were not always robust as the discrepancies in care plans that we found and risk assessments that were no longer relevant had not been picked up by the audit process. Whilst we found that the registered manager was open and responsive to issues we raised during the inspection, the processes in place to identify issues on an ongoing basis were not effective.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns and these were being reported to the local authority and the necessary notifications were now being submitted to CQC.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. Everyone we spoke to confirmed that there were enough staff and staff were observed to be carrying out their duties in a timely manner. The home was managed and staffed by a consistent team of care assistants who were well supported.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity

The inspection was unannounced and took place on 12 and 13 December 2016.

Applecroft is a privately owned care home located near to Congleton town centre and close to local shops. It is a three-storey building and people can be accommodated on all floors. Access between floors is via a passenger lift or stairs. There are 22 single bedrooms in the home; 16 of them have en-suite facilities.

The service was last inspected in July 2014 when we found two breaches in the regulations. The provider was in breach of the regulations in relation to consent as the provider was not acting within the principles of the Mental Capacity Act 2005. They were also in breach of the regulations around premises as there were a number of outstanding repairs.

The home has a registered manager. 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. At the time of our inspection there were 21 people living in the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach in the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the back of this report.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We saw that whilst applications had been made appropriately, consent to care had not been recorded on any of the care files and the latest guidance for covert medication had not been followed.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns, however we did find one instance where a safeguarding incident had not been reported. The registered manager had not submitted the necessary notifications to CQC where incidents of safeguarding had occurred.

We saw that whilst there was now a system in place for reporting maintenance issues, we found some maintenance issues which were addressed during the course of our inspection.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’, however we found some where little information had been recorded about the person’s history and preferences.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. The areas for improvement that had been picked up by these systems had not been acted upon.

The home was clean and provided a calm, relaxing atmosphere. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. However other checks on the fire doors and emergency escape routes had not been completed regularly.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults. The home was managed and staffed by a consistent team of care assistants who were well supported.

We found that there were sufficient

During our inspection of Applecroft Residential Care Home we talked with six of the people who used the service and spent time with them and other people in the lounge and dining room as well as visiting individual rooms. We found that people engaged in the activities which were provided and that the staff related to them positively.

We wanted to check that people were given the opportunity to consent to the care and treatment offered to them. One person who used the service told us “You feel free to express whatever you feel” and “Sometimes you say you don’t like something and the staff remember that and take note”.

We talked with care staff as well as the cook and the manager of the home. They showed us a number of records we wished to see as part of our inspection and also demonstrated the computerised care planning and staff records system. We found that most of the records kept by Applecroft Residential Care Home in relation to care planning, equipment, and staff recruitment were satisfactory.

We checked that the equipment used in the home was satisfactory and was well-maintained. We looked at the systems which the home used to provide information so that the quality of care being provided could be monitored.

We interviewed three people who use the service. In the main they were complimentary about the service provided at the Home saying that there was “a reasonable amount of choice” and that “you could choose to stay in your room or go downstairs for meals”. Some people told us that the staff were “very nice” and that they could “tell them what I like and dislike - they give you everything else you want”.

We met two relatives who were visiting a person using the service. They told us “it’s small and homely. Anyone could be happy here”.One person told us about activities that were available in the Home such as games and we observed staff interacting with people and playing musical instruments with them. However one person asked to see us on their own and told us that they thought that there was “not enough choice” and that people using the service were “treated as patients”. This person felt that the Home should “help people to make their own decisions” and encourage people to “use initiative”.

We met with the owner of Applecroft and discussed recent developments in the Home. We interviewed the Assistant Manager who described current arrangements there. It was clear that Applecroft had very recently gone through a period of change but that plans and arrangements had already been put in place in order to sustain the service to the people who live there. We interviewed and spoke to three members of care staff who confirmed that these plans were having a positive effect.

We spoke with seven people who were living at the service and one relative during our visit. Their comments were mixed about the service but overall were positive about the care received. Four people told us they liked living at the service and used word to describe it such as; “It’s lovely here” and “I’m very happy here.” One relative was able to tell us that they were happy with the service and that the standard of care was always good whenever they visited. They advised they were always made to feel welcome when they visited and was always offered a ‘cuppa’.

Two people told us they thought the food was “awful” and both felt it could be better. Three people told us they had been cold on occasions lately, especially at night. We discussed these comments with the manager who agreed to review these issues with the people living at the service and she agreed to review the heating arrangements for everyone at the home to ensure they were kept warm and comfortable at all times.

When we visited Applecroft we had the opportunity to observe the care that was being given to people living at the service. 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 noted that everyone was well dressed and well groomed. We saw many examples of good communication and patience by care staff, who interacted with people in a positive manner.

The people who are using the service told us that they were being treated with dignity and respect and that the staff members were very good. One person told us; “the staff always look after me”. Another person said; “Nowhere better”.

The people using the service told us that they were able to move freely around the home and that they were able to make choices in a number of areas of daily living; for example, times of rising and retiring and where to spend time and with whom.

The people we spoke to during the visit all said that the standard of food provided was very good, one person told us; “the food is good”.

The people we spoke to who were able to respond all said that they were happy living at Applecroft and that they would tell the staff members if they had any concerns.

The people using the service that we spoke to all made positive comments about the staff members working in the home and their attitude towards them.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. The last inspection of Applecroft Care Home took place in November 2013 when it was found to be meeting all the regulatory requirements that we looked at.  

Applecroft Residential Care Home has a registered manager in place.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that the home needed more robust arrangements to make sure that people had access to the provisions of the Mental Capacity Act. The Mental Capacity Act outlines the arrangements which must be made when someone becomes unable to make some decisions for themselves. The home did not have arrangements in place to implement best interest or Deprivation of Liberty Safeguards (DoLS) arrangements which form part of this. This is a breach of regulation 18 of the relevant regulations. You can see the action we told the provider to take at the back of the full version of this report.

We saw that repairs were required to the building and fittings. This meant that the provider did not comply with the relevant regulation 15 relating to this. You can see the action we told the provider to take at the back of the full version of this report.

We found that care needed to be based more around individual people’s needs and preferences and a wider choice of activities offered to the people who lived at the home. We did not see evidence of sufficient engagement by the owner of the home.

People felt that they were safe from harm and staff knew how to safeguard them. Safeguarding means taking steps to make sure that people who use services do not suffer abuse and responding appropriately if there are any allegations or suspicions of abuse. There were sufficient staff and they had access to training. The provider used safe recruitment practices to make sure that staff were suitable to work in the home.

People said they liked the food at the home. We checked that the cook planned menus in a way that ensured that people received adequate food and drink. Staff at the home were kind and caring and the management team involved themselves in the care being provided.