We carried out an unannounced comprehensive inspection at Applegarth Residential Care Home in September 2016 and rated the service as ‘Good’.

Since that inspection we received information about a serious incident which took place at the home. This incident is subject to investigation by the relevant authorities and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk associated with people’s needs and the environment. We undertook a focused inspection to check people were safe. This report only covers our findings in relation to these topics.

This inspection took place on 7 March 2018 and was unannounced.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Applegarth Residential Care Home on our website at www.cqc.org.uk

Applegarth Residential Care Home accommodates a maximum of 23 older people in one adapted building across two floors. On the day of our visit 21 people lived at the home. The home is located in Coventry in the West Midlands.

This service 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.

The home had a registered manager who had been in post since 2016. 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.

Some risks associated with people’s health and well-being and the environment were not always well managed. Records to support risk management in the home lacked detail and were not being accurately completed. Action was being taken to address this.

People received their medicines as prescribed from staff who had been trained in managing medicines safely. However, systems to ensure medicines were administered and managed in line with the provider’s procedure were not always effective and required improvement.

People told us they felt safe living at the home. Staff understood their safeguarding responsibilities and the action they should take if they were concerned a person was at risk of harm.

There were sufficient staff to meet people’s needs. The provider ensured pre-employment checks had been completed before staff started work to make sure, as far as possible; they were safe to work with the people who lived there.

The provider encouraged people and relatives to share their views about the home and how it was run to drive forward improvements. The registered manager used learning from accidents and incidents to make improvements.

Staff enjoyed working at the home and felt supported and valued by the management team.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection on 12 September 2016.

The service was last inspected in June 2015 where we found improvements were required in the management of the home, risks management and care recording. We also had concerns about the management of medicines, and how people, who lacked capacity to make decisions, were supported. We asked the provider to take the necessary steps to ensure the required improvements were made. At this visit we found improvements had been made in all these areas.

Applegarth Residential Care Home provides care for a maximum of 25 people. At the time of our inspection there were 19 people who lived at the home. Some people stayed at the home on a short term basis when leaving hospital, with the aim of returning back to their own homes.

The service had 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. The registered manager had been in post since February 2016 and registered since June 2016. We refer to them as the manager in the body of the report.

Care plans contained information for staff to help them provide personalised care, were up to date and accurately reflected people’s care needs. People and relatives were involved in reviews of the care provided.

People told us they felt safe living at the home because staff came quickly when they requested assistance, and offered them reassurance when required. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff were effective in identifying risks to people’s safety and in managing these risks.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to reduce the risks of unsuitable staff working at the service. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time.

Staff encouraged people to be independent, and people had gained increasing skills and confidence in their daily lives.

People received medicines from trained staff, and medicines were administered safely.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required. The manager had arranged for the correct assessments if they felt people may be being deprived of their liberty.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided. People were assisted to manage their health needs, with referrals to other health professionals when required.

People had enough to do to keep them occupied and staff tailored activities to people’s individual interests. Staff supported people with one to one social stimulation if this was their preference.

People knew how to complain and could share their views and opinions about the service they received. There were formal opportunities for people to feedback any concerns at meetings and through surveys.

People were positive about the changes in management of the service and the improvements which had made to the environment.

Staff told us they could raise any concerns or issues with the managers, who were approachable and responsive. There were formal opportunities for staff to do this at meetings and one to ones.

There were processes to monitor the quality of the service provided. There were other checks which ensured staff wo

This inspection took place on 26 June 2015 and was unannounced.

Applegarth Residential Care Home is registered for a maximum of 25 people and provides accommodation for people who require nursing or personal care. At the time of our inspection there were 14 people living at the home.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We decided to inspect this service earlier than planned due to a number of concerns we received about how people were supported and the care they received.

Some staff felt that they could not raise concerns with the registered manager and that they had not always been aware of everything happening in the service in relation to the recent safeguarding concerns.

Concerns had been raised in quality assurance questionnaires, but we were unable to see any responses to these. Complaints received were not always recorded so we were unclear if these were dealt with to people’s satisfaction.

Records maintained, including people’s personal care records did not always reflect the levels of care people required and were not always available or accurate.

The registered manager told us they understood what they needed to notify us of any incidents so we were able to monitor the service; however we saw they had not notified us of all safeguarding referrals.

Medicines administration was inconsistent and did not guarantee that medicine would be administered in response to people’s needs. Records were not always completed correctly and medicines were not always stored and disposed of safely. There was no a clear system in place for medicine to be given at night without the registered manager coming in to administer this.

People told us they felt safe, however staff did not feel able to raise concerns about potential abuse, although they had received safeguarding training and were aware of how to do this. There were enough staff to care for people, but some staff told us they were covering extra duties and they found this demanding.

Risk assessments did not always reflect current risks to people’s health needs and how to minimise or prevent these to keep them safe.

Staff received training to support people with their health and social care needs. Staff told us they received some support by the management team, but this could be improved, as one to one and group staff meetings were held frequently.

Where people did not have capacity to make decisions, support was not always sought in line with the Mental Capacity Act 2005. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) however this was not always done in a timely way.

People were offered a choice of meals and drinks that met their health and nutritional needs and systems made sure people received support from appropriate health care professionals when required.

Some staff supported people with kindness but other staff did not. Staff were attentive to people’s physical needs but we saw there were missed opportunities to interact with people.

People were encouraged to be independent where possible, and care was provided ensuring dignity and respect. People were given choices about how to spend their time, and their preferences were catered for where possible.

People’s care records did not always reflect the level of care and support people required however we saw staff knew people’s care needs. Some activities were available for people to enjoy, but people told us they felt their social needs were not always fully met.

Overall people were positive about the registered manager and some staff told us they were approachable. There were systems of checks and audits to ensure the care provided was effective, but these had not identified concerns about care records. Systems to ensure the home environment and equipment was safe were comprehensive and up to date.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection was carried out by one inspector. At the time of our inspection there were 23 people who were using the service. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people who used the service, three staff who were supporting them and from looking at records. This evidence helped us answer the five questions detailed below.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe and we observed a relaxed atmosphere.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We found that people received their medicines as prescribed by the doctor.

There were risk management plans in place for people and health and safety. We noted that the premises were appropriate, well maintained and safe for the people who were using the service.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. When people were admitted to hospital the manager re-assessed them to make sure the home was able to continue to provide their care when they ready to be discharged. There was evidence of people and or their relatives being involved with the development and regular reviews of care plans. Staff encouraged and supported people in leading interesting and enriched lifestyles. The people we spoke with all said they received the standard of care that matched their needs. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

The people we spoke with were positive about the way they were cared for and supported. A person told us: "Staff look after me well." People were cared for by kind and attentive staff. We observed people asking staff to do things for them. Staff responded to the requests promptly and efficiently. The home was supported by a team of health and social care professionals who worked closely with staff in providing people's care needs.

Is the service responsive?

When people who lived in the home made suggestions for changes these were actioned as far as practically possible. The service worked well with external healthcare professionals to make sure people received good standards of care. Records confirmed people’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. Regular audits had been carried out that enabled staff to make changes that could be of benefit to the people who used the service. Staff told us they were clear about their roles and responsibilities and the ethos of the service. Staff received regular supervisions by senior staff to ensure they were competent for their roles.