The inspection took place on the 29 June and 5 July 2018 and was unannounced.

Cromwell Court Care Home was previously inspected in January 2017. During the inspection we found breaches of Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the registered person had failed to maintain accurate records necessary for the management of the regulated activity. Furthermore, we found that the registered person had failed to clearly demonstrate that staff employed by the service had received training appropriate to the work they perform.

At this inspection we found that the registered provider had taken action to address the breaches identified at the last inspection.

During this inspection we found a breach of Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 related to notification of incidents.

We found that the registered person had not always notified the Commission of incidents or allegations of abuse. We have written to the provider regarding their failure to notify us.

Cromwell Court is a ‘care home’ run by DRB Healthcare Limited. 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.

The care home is two-storey purpose built building that is situated in the centre of Warrington. It is located close to bus routes, a train station, local shops and other public amenities.

Cromwell Court is registered to accommodate up to a maximum of 67 people across four separate units, each of which have separate adapted facilities. The home was awaiting refurbishment work to commence on the first floor and therefore only two units on the ground floor were in use. At the time of our inspection, the care home was therefore accommodating 27 people.

The care home did not have 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 care home provided a homely, comfortable and relaxed environment for people to live in. People could receive visits from family members and friends each day and staff were seen to be attentive and responsive to the needs of people using the service.

We found that people’s needs had been assessed and planned for and that a range of risk assessments had been completed to ensure staff were aware of how to keep people safe.

Appropriate arrangements were in place for checking the environment was safe. For example, equipment and services were routinely serviced and health and safety audits were completed on a regular basis. Accidents and incidents were also reported and recorded appropriately.

The provider had developed policies and procedures relating the Mental Capacity Act 2005 and deprivation of liberty safeguards. Staff had completed training in this key legislation and staff spoken with understood the needs of the people they cared for including people who lacked capacity. People were observed to have choice and control over their lives and staff supported them in the least restrictive way.

We found that staff’s suitability to work with people using the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken.

Staff had received access to induction, mandatory, service specific and qualification level training in addition to formal and informal supervision. This helped to equip staff with the necessary knowledge and skills to ensure people received appropriate care.

Systems were

This inspection was unannounced and took place on the 30 January and the 01 and 02 February 2017.

This was the first inspection of Apple Court following a change of service provider.

Apple Court Care Home is a purpose built care home located in the centre of Warrington. It offers accommodation, personal and / or nursing care for up to 67 older people with memory problems associated with dementia. At the time of our inspection the service was providing accommodation to 47 people.

At the time of our inspection one of the area managers was registered as the manager of the service. 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.

A home manager had recently been appointed who was due to apply for registration with CQC as a matter of priority. The home manager had extensive experience in the management of residential services for people living with dementia.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of good governance and staffing. A number of audits could not be located during our inspection and significant gaps in training were noted for some staff. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we undertook a Short Observational Framework for Inspection (SOFI) during our inspection and noted that people using the service appeared calm and relaxed in their home environment. We also saw that staff interactions were positive and that people using the service were treated with dignity and respect.

Systems had been established to ensure that staff working at Apple Court had been correctly recruited and to ensure people were protected from abuse. A complaints process was also in place to ensure concerns and complaints were listened to and acted upon.

People had access to health care professionals subject to their individual needs and medication was ordered, stored, administered and disposed of safely.

The home was going through a period of transition following the registration of a new provider. The management team shared with us their future plans and demonstrated a commitment to addressing outstanding issues and to developing and improving the overall service provided at Apple Court.