This inspection took place on 12 June 2017 and was unannounced. At the last inspection, in February 2015, the service was rated Good with requires improvement in our question ‘Is this service safe?’ At this inspection we found that the service remained Good and rated Good in all of the five key questions.

Cuerden Developments Limited – Appleby Court Care Home is a purpose built, two storey care home which provides both nursing and residential care for a maximum of 81 people. At the time of the inspection there were 67 people using the service.

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.

People received safe care. People received their medicines in the way that had been prescribed for them. People's individual care and support needs were met and systems were in place to protect people from abuse and avoidable harm. Risks to people's health and wellbeing were identified, managed and reviewed. There were enough staff available to meet people's needs who had been employed in line with the provider's safe recruitments procedures.

The care that people received continued to be effective. People made decisions about their care and staff sought people’s consent. Where people lacked capacity they were helped to make decisions. Where their liberty was restricted, this had been identified and action taken to ensure this was lawful. People received supported with their health care and nutritional needs. Staff received training to meet the specific needs of people who used the service.

The care people received continued to be good. People were treated with dignity and staff were caring and kind. Staff helped people to make choices about their care and their views were respected. The care records detailed how people wished to be cared for and people received individualised care and support that met their needs.

The care people received continued to be responsive. People were involved in the care and support they received and relatives continued to play an important role. Where people had any concerns they were able to make a complaint and this was responded to.

The service continued to be well-led. Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service on how improvements could be made. The manager promoted an open culture which put people at the heart of the service.

The unannounced inspection took place on 19 February 2015. At the last inspection in July 2014 the service was found to be non-compliant with regard to staffing levels at night time on the two nursing units. Some improvements have been made to by the service to reduce the length of the night time medicine round so that staff have more time to attend to the needs of the people who use the service.

Appleby Court Care Home is a purpose built, two storey care home which provides both nursing and residential care for a maximum of 81 people. At the time of the inspection there were 74 people using the service.

There was a registered manager, who was not present on the day of the inspection. 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.

There were robust medication systems in place for administration, storage and disposal of medicines in place.

However, we found that there was still a concern about the length of the night time medication round on the nursing units. This was due to the round taking a significant length of time to complete and only one qualified nurse on shift to administer the medicines. Although this was not currently having a significant impact on people who used the service, we found that people were not always getting their medicines at night in a timely way. We have made a recommendation about consulting current best practice guidance around medication administration.

People who used the service told us they felt safe and secure and sufficient staff were in place on the day of the visit to administer care safely. Appropriate health and safety and emergency contingency plans were in place.

The home had robust recruitment procedures for new staff. This included, taking up two references, an application form, obtaining proof of identity and undertaking Disclosure and Barring Service (DBS) checks to ensure staff were suitable to work with vulnerable people.

Policies and procedures for safeguarding vulnerable adults were in place and staff demonstrated a good understanding of safeguarding issues.

People reported that the food at the home was good and that changes to the menus had been made in response to their suggestions. We saw that a choice of meals was offered and people were given sufficient drinks throughout the day.

We looked at seven care files and found they included a range of personal and health information and were complete and up to date. We saw that care files were person centred and met people’s individual needs and preferences. People were able to access services from other agencies and professionals whenever this was required.

Although there was little evidence of written consent within the care plans there were references to staff obtaining consent within each part of the files. The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff induction was robust and included mandatory training, shadowing and competency assessment. Staff training was comprehensive and on-going.

We observed staff throughout the day interacting with people in a respectful and courteous way. We saw that staff made efforts to preserve people’s dignity and privacy when offering assistance.

Information was given to people who were thinking of using the service and their relatives in the form of a service user guide, which was a leaflet that gave some details about the service. Each person who used the service had a service user guide in their bedrooms.

Residents’ and relatives’ meetings were held regularly, approximately six to eight weekly, to ensure people had a forum to raise concerns and put forward suggestions.

The home made efforts to ensure that people’s choices for end of life care were respected.

We saw the activities timetable which advertised a number of activities. People told us there were many events and activities which took place within the home on a regular basis.

There was an up to date complaints policy which was outlined in the service user guide of which each person who used the service had a copy. We saw the complaints log and this evidenced that complaints were followed up appropriately.

We were told by people who used the service that they felt the registered manager was approachable.

Staff said they felt well supported in their roles and supervisions and appraisals were undertaken on a regular basis. Staff meetings were also regularly held, ensuring staff had a forum to raise concerns and discuss issues.

A number of audits and quality checks were carried out at the home to ensure quality was monitored and improvements made on an on-going basis.

We carried out this inspection as a response to concerns raised about staffing levels on the nursing units during the night.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at respect and involvement, care and welfare, staffing, quality assurance and complaints.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families and looking at records:

Is the service caring?

During the visit we saw staff offering care and support in a polite and courteous manner. Staff were patient and friendly and made efforts to ensure people’s dignity and privacy were preserved at all times.

The home had a range of ways for people who used the service to voice their opinions, offer suggestions and raise concerns. There were six monthly questionnaires, from which the results were analysed and any issues addressed. There were also six to eight weekly relatives meetings, a monthly newsletter and regular communication between staff and people who used the service and their visitors. The manager had an open door policy so that people could speak with them whenever they wanted to.

There were a number of activities on offer, such as trips out, exercises, reminiscence, games and entertainment. We spoke with five people who used the service and two visitors. They were all positive about the home and the staff. One person said, “I’m champion, I like this place. They (the staff) are mostly nice. They take me into Wigan once a week”. Another person told us, “You get a good laugh with them (the staff) and they are helpful. If you want something they will help you in any way they can”. Others were also positive about the care they received, activities undertaken and the home in general.

Both visitors with whom we spoke felt their relatives were well looked after. One commented, “I am quite pleased with the home. They have been very helpful and I appreciate their help. I’ve not found anything to find fault with”.

Is the service responsive?

We saw that staff responded promptly to summons by call buzzers from people who used the service.

Thorough assessments were carried out prior to them moving in to ensure their needs could be met and the placement was appropriate. We saw a new document for recording personal information, social histories and personal preferences in an effort to make care more person centred and individual.

We saw evidence that changes had been made, to activities and menus, in response to concerns raised and suggestions made by people who used the service.

Care plans and risk assessments were reviewed and updated regularly and changes made as necessary to ensure they reflected people’s changing care needs.

Is the service safe?

There were sufficient numbers of staff on duty at the home on the day shift, but rotas, staff comments and dependency levels of people who used the service showed that staffing levels were inadequate on the nursing units on the night shifts.

Although no one was currently subject to Deprivation of Liberty Safeguards (DoLS), the manager demonstrated a good knowledge of the subject which would help ensure people were deprived of their liberty only in their own best interests and with the least possible restrictions. The manager had ensured that they were up to date with the local authority guidelines and the recent changes.

Staff training was up to date and on-going and staff with whom we spoke had a good knowledge of the care planning process and how to deliver care in accordance with individual care plans.

Risk assessments, such as falls, nutrition and moving and handling were in place in the care records and were reviewed and updated regularly to ensure people’s needs were met safely.

Health and safety checks were carried out regularly and all equipment was well maintained. The manager had plans in place to complete Personal Evacuation Plans (PEEPs) for all individuals so that staff and emergency service personnel would be aware of the level of support required by each person in the event of an emergency.

Accidents and incidents were appropriately recorded and followed up and lessons learned in order to help minimise the risk of further similar incidents in the future.

Is the service effective?

Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities.

Care plans we looked at included factual and up to date information about people’s health and support needs.

Recent questionnaires filled in by people who used the service indicated a high level of satisfaction. Residents and relatives meetings had proved popular and were well attended. We saw suggestions, concerns and ideas had been taken on board and responded to by the home.

The people who used the service with whom we spoke felt the care provided was effective and appropriate. We spoke with two visitors who agreed that their relatives were cared for appropriately and well.

Is the service well-led?

The home had a manager in place, who was appropriately registered with the Care Quality Commission.

A range of audits and checks were in place at the home to help ensure consistent standards of care within the home.

Questionnaires were regularly completed with people who used the service, to gain their opinions and suggestions and gauge their level of satisfaction. Results were analysed and used to inform continual improvement to the service.

Complaints were dealt with in a timely and appropriate manner.

Since the previous inspection that took place in January 2013 a new manager had been appointed. Staff members spoke positively about the home manager and described her as very approachable. Comments included, “she makes you feel settled” and “the manager is brilliant, very supportive”.

The people using the service who were able to tell us said that they were happy living in the home and that the staff members were good. Comments included; “as good as it could be, staff are good” and “staff are looking after me”, “angels, so kind”, “staff are excellent, definite improvement with the new manager”, “staff are very nice” and “staff are absolutely brilliant, very friendly”.

The visitors we spoke with also made positive comments including, “I am always made to feel welcome” and “staff are looking after her well”.

There were effective recruitment and selection processes in place and all new staff members completed an induction training programme so they had the skills they needed to do their jobs effectively and competently.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis via feedback from the people who used the service and their representatives, including their relatives and friends.

During our inspection we spoke with five people living at Appleby Court care home and three visitors. People told us that they were happy living there and they thought that they were well looked after. We received numerous positive comments about the staff such as “the staff are great”; “staff are brilliant”; “the staff are belting”(really good) and “the staff looked after me well.” We received two negative comments one was about the timing of meals and the other was about staff being in a rush when they were short staffed.

We found the people were well cared for and that staff always asked for permission to start care tasks. One person told us “The staff are polite and always ask me what I want before giving me any care.”

We found that there were effective systems in place to prevent and control infections within the home. We observed good hand hygiene practice and saw the appropriate protective equipment was worn by staff at the correct times.

We found that staff were happy working at Appleby Court and that they had received relevant training. They told us that they were supported in their role and that the manager was approachable.

We saw that there were appropriate systems in place to monitor the quality of care that people received the home. We found that accident and incidents were reported and monitored and that the provider responded to any complaints made by people.

People told us that they received information on the service provided prior to admission.

People told us that they were able to visit the home prior to making a decision to live there.

People told us that they felt safe.

People told us that the staff were caring.

People told us that they were treated with dignity and respect.

People told us that they were able to make choices about how they wished to spend their day.

People told us that the food was good and choices were available.

People told us that there are a lot of activities provided.

People told us that there were sufficient staff on duty to meet their care needs.