About the service: Appleby Lodge provides residential care to people over the age of 65.

People’s experience of using this service:

People and staff told us the service was well managed. People said they were treated with kindness and compassion and felt respected. Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere. People’s wellbeing was promoted.

There were positive working relationships with external professionals and a passion for continuous learning and improvement.

People were kept safe and protected from avoidable harm and abuse, and people now had their medicines safely managed. New processes had been put into place to ensure a more robust oversight. People now lived in an environment which was fully assessed for safety.

People received personalised care and support, and had their human rights protected. Staff were competent in their roles and were well supported. Quality monitoring systems had been further developed. However, we have recommended the provider takes action to continue to strengthen their overall governance systems, because the system had not identified that some records were not always in place, or up to date.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (published 21 March 2018).

Why we inspected: This was a planned inspection. At this inspection we rated the service Good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out a previous comprehensive inspection on 12 and 15 June 2017. The service was rated Inadequate and was placed into special measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

We told the provider to make improvements to ensure people’s medicines were managed safely, that the environment was checked to ensure it kept people safe, and risks associated with people’s care were recorded. We also told the provider to ensure staff had the necessary training to be able to safely and effectively support people, that people’s human rights were protected in line with the Mental Capacity Act (MCA) 2005, and that people’s care records showed their involvement in decisions relating to their care. As well as being kept up to date and in line with their wishes and preferences. Action was also required to ensure people had enough to stimulate their social and cognitive needs, and that people’s privacy and dignity was respected, particularly at the end of their life. In addition, we requested the overall management, leadership and culture of the service should be improved and asked the provider to implement an effective monitoring process, to help capture people’s views and identify when improvements were required.

Immediately after our inspection, the provider told us they would stop new admissions to the service, in order for them to put things right. We also contacted the local authority safeguarding team who took prompt action to ensure people's health, safety and wellbeing.

The Commission considered its enforcement policy, and took enforcement action, which was to impose a condition on the provider's registration. This meant on a monthly basis, the provider was requested to carry out an audit of people’s care plans and risk assessments, the management of people’s medicines, and equipment and environmental maintenance. Submit a summary of their findings to the Commission, and demonstrate what action was being taken to improve the service and to meet regulation. Since October 2017 the Commission had been receiving and reviewing the provider's monthly returns, which had demonstrated ongoing improvement at the service. However, during our most recent inspection although we found some improvements had been made, our findings relating to people’s care plans, risk assessments and medicines management showed the information which had been provided had not always been fully accurate. This demonstrated the providers auditing systems had not always identified where improvements were required and continued to require adapting.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures, but further improvements are still required. The Commission also made a decision to remove the providers imposed condition of registration.

We carried out an unannounced comprehensive inspection on 29 January 2018 and 08 February 2018.

Appleby Lodge 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 care home provides accommodation for up to 18 older people who require personal care. The provider also operates a day centre offering meals and companionship to local people. The service is on one level. There are shared bathrooms, shower facilities and toilets as well as a lounge and dining area. There were 15 people living at the home at the time of our inspection and one person using day care facilities.

Since our last inspection the manager had now registered with the Commission and was now the registered manager of the service. A registered manager is a pers

The overall rating for this service is 'Inadequate' and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out a previous comprehensive inspection on 09 September 2015 and 11 September 2015 and the service was rated Good.

We have since carried out an announced comprehensive inspection on 12 June 2017 and 15 June 2017. Prior to our inspection the Commission had received concerns regarding the leadership of the service, the recruitment of staff, staffing levels and the management of people’s medicines. During our inspection we looked into the concerns which had been raised.

Appleby Lodge provides accommodation for up to 18 older people who require personal care. The provider also operates a day centre offering meals and companionship to local people. The service is on one level. There are shared bathrooms, shower facilities and toilets as well as a lounge and dining area. There were 15 people living at the home at the time of our inspection and two people using day care facilities.

People told us they received their medicines when required, however people’s medicines were not always managed and stored safely.

People lived in an environment which had not been assessed to ensure it was safe. Weekly fire tests were not always carried in line with the provider’s policy. People had personal emergency evacuation plans in place (PEEPs), however these had not been updated to reflect people’s changing care needs. PEEPs help to give a summary of people's individual needs for the emergency services in an event such as a fire. Following our inspection, because of concerns identified, we contacted the fire authority.

People were not always protected from risks associated with their care. People did not always have risk assessments and care plans in place relating to their individual care needs, and when these were in place, they were not reflective of people’s current care needs. This meant staff did not have the most up to date recorded information to enable them to know how to support people safely. However, whilst information was not documented, staff did know people well and communicated with each other about how to meet people’s needs at staff handovers and through-out the day.

People told us they felt safe living at Appleby Lodge. People were supported by sufficient numbers of staff to meet their needs. People’s needs were taken into consideration in determining staffing levels. People’s call bells were answer

We (the Care Quality Commission) carried out this inspection as part of our planned review of inspections.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Five people all told us how happy they were living at the home and that they felt very well cared for by the staff of Appleby Lodge. They told us, “I am looked after far too well, I have not a care in the world” and “ The things that are important to me are all done by the staff ".

There was a low staff turnover and this meant staff knew people’s needs well.

Further monitoring of medicines practice was needed to ensure all areas are safe.

The acting manager undertook some recruitment checks for new staff. Further checks were needed to be undertaken and recorded to ensure that people continued to be cared for safely.

The care provided, environment, care planning and medication were all monitored by the acting manager to maintain the quality of the service though this had not covered all aspects of safety in the service. They demonstrated that they were responsive to people’s views and were developing social activities.

Records relating to people’s care were personal to ensure that people’s choices and preferences would be met by staff.

We (the Care Quality Commission) carried out this inspection as part of our scheduled inspection programme.

We talked with nine people who lived at the home. Comments from people who lived at the care home included,

“This is a wonderful home, you really can’t fault it in any way and I am a very fussy person “, “They help me get up when I am ready and I can go back to bed when I want to “, ” when you ring the call bell, they soon come”, “This is the best home around here” and “The food here is excellent”.

We pathway tracked four people who use the service. Pathway tracking means we looked in detail at the care four people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

All of the people we spoke with said that they felt safe and would feel able to complain if they needed to.

We saw that the home had a comfortable homely feel and that the home was clean and had no offensive odours.

We looked at the systems in place to check the quality of the service. We found that auditing systems had been put in place and efforts had been made by the management to monitor the service and address any problem they found. By doing this, they could develop and improve the service they were providing.

This was an unannounced inspection on 9 September 2015 and 11 September 2015.

We last inspected Appleby Lodge in May 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

Appleby Lodge provides accommodation for up to 18 older people who require personal care.

There were 18 people living at the home at the time of our inspection, one of whom was in hospital. The home is on one floor. There are shared bathrooms, shower facilities and toilets as well as a lounge and dining area.

The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were well supported by staff who were kind and caring. Where able people told us they enjoyed living in the home. Comments included; "I'm very, very pleased. Its very nice." "it's a very, very good place" and "I don't think it would be possible to make it any better."  People and staff were relaxed throughout our inspection and people were often seen laughing and joking. One relative commented, "There is a good atmosphere in the home." People’s friends and families were welcomed by staff.

People or, where appropriate, those who mattered to them told us they felt safe. All staff had undertaken training on safeguarding vulnerable adults from abuse. They displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. Safe recruitment procedures were in place. Staff underwent the necessary checks which determined they were suitable to work with vulnerable people, before they started their employment. There were enough staff to meet people’s needs and people also confirmed this. The staffing structure was flexible in meeting the needs of people.

People received an individualised approach to their care and told us, "They've been so good all the time, nothing's too much trouble. We're lucky to have such lovely staff." People’s care plans held information regarding illnesses or conditions people were living with, so staff could support them effectively. People’s risks were managed well and monitored within risk assessments. Staff responded quickly to people’s change in needs and care plans were updated accordingly. However people, and those who mattered to them, were not consistently involved in reviewing their care plans. This meant that people were not completely in control of the care they received. The registered manager told us they would discuss with people and those who mattered to them, how they would like to be involved. People told us their privacy and dignity was maintained.

Some care plans included people's personal histories to help staff get to know people and the registered manager told us they were completing these in everyone's files. There were a variety of social activities available and some staff were attending training on how to provide tailored activities for people. The registered manager was trying to find new ways to give people the option to go out into the local community, as previous attempts had been unsuccessful.

People told us the meals were nice and people were offered choices, "it's a wonderful place to be in, the staff are excellent and the food is beautiful." People’s nutrition was monitored and people’s care files held information on ‘signs of nutritional risk’.

People and those who mattered to them knew how to raise concerns and make complaints. The service had not received any complaints but people told us concerns raised had been dealt with promptly and satisfactorily.

People’s personal confidential information was not always stored securely. This meant that it was easy for someone to access people’s confidential information. People’s medicines were administered safely but spare medicines were not always in a locked cupboard. This meant that people’s medicines were accessible to other people. The registered manager told us after the inspection that a lock had been installed on the cupboard used to store medicines and files containing confidential information were now also stored securely.

People were supported to maintain good health through seeing healthcare professionals, such as GPs and district nurses, regularly. External health and social care professionals were complimentary about the staff and the care home commenting, "I think the staff are very kind and caring."

Staff described the management as supportive and approachable. Staff talked positively about their jobs and colleagues, comments included: "I enjoy it. I receive a compliment about my work and I feel useful" and "we're a good team." Staff had received training to enable them to provide effective care and support to people. Senior staff regularly observed staff practice to improve quality and the registered manager told us they had not previously held formal one to one meetings with staff to discuss their work but intended to start immediately.

The registered manager was knowledgeable about people; they took a hands-on approach to the management of the care home and had an "open door" policy that everyone was aware of. There were quality assurance systems in place to monitor and improve the quality of the service.