Appleton Lodge is a purpose built care home owned by HC-One Limited. The home is registered to provide residential care and accommodation for up to 30 people with dementia, older people, younger people or people with a physical disability. On the day of our inspection there were 30 people using the service.

Appleton Lodge is a two-storey building situated next to a larger sister building on the same site. All bedroom are single occupancy and have en-suite facilities. There is an enclosed garden to the rear of the building accessed by a conservatory. Car parking is available within the grounds.

This inspection took place on 5 September 2018 and was unannounced. This meant the staff and the provider did not know we would be visiting.

Appleton Lodge was last inspected by CQC on 23 September 2015 and was rated Good.

Appleton Lodge is a 'care home'. 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 home had a registered manager in place. A registered manager is a person who has registered with CQC 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 understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

People were protected from the risk of poor nutrition and staff were aware of people's nutritional needs. People had access to healthcare services and received ongoing healthcare support. Appropriate arrangements were in place for the safe management and administration of medicines.

People who used the service and their relatives were complimentary about the standard of care at Appleton Lodge.

Staff treated people with dignity and respect and helped to maintain people's independence by encouraging them to care for themselves where possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the home and within the local community. The service used innovative activities to enhance people’s lives.

Care records showed people's needs were assessed before they started using the service and care plans were written in a person-centred way and were reviewed regularly. Person-centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account. Care plans were in place that recorded people's plans and wishes for their end of life care.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty to meet the needs of people who used the service.

Staff were supported to provide care to people who used the service through a range of mandatory training, supervision and appraisal. Staff said they felt supported by the registered manager.

The home was clean, spacious and suitable for the people who used the service. The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out. Accidents and incidents were appropriately recorded and risk assessments were in place where required.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

The provider had a quality assurance process in place. People who used the service, relatives and staff were regularly consulted about the qua

This was an unannounced inspection to this location. This inspection took place on 23 September 2015

The service was previously inspected on 4 September 2013 when no breaches of legal requirements were found.

We visited this location following concerns raised at a Coroner’s Inquest in February 2015. We wanted to check that appropriate action had been taken by the service to minimise the risk of other deaths occurring in similar circumstances.

Appleton Lodge is a purpose built care home owned by HC-One, it is a two storey building situated adjacent to a larger sister building on the same site. The home is registered to provide residential care and accommodation for up to 30 people. All bedrooms have single occupancy and some have en-suite facilities. There is a passenger lift providing access to the first floor. There is an enclosed garden area to the rear of the building accessed via a conservatory area. Car parking is available within the grounds.

When we visited the service there was no registered manager in place. 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 was in place and an application to become registered has been submitted to the Care Quality Commission (CQC).

Concerns about the home which were identified at a Coroner’s Inquest in February 2015 had been addressed and actioned. There was a clear Falls Protocol in place. All falls were recorded with a full description of how the incident occurred; what immediate action was taken and the level of harm caused. Risk of falls had been assessed for each person living at Appleton Lodge and care plans identified ways of minimising risk

People said they felt safe in Appleton Lodge. One person told us, “I am safe here. They come and check that I’m alright. I sleep well at night.” People spoke positively about the care staff and the manager, and we saw that care was provided in a way which promoted people’s abilities, needs and wishes.

There were systems in place to ensure that people who used the service were protected from the risk of harm. Staff had received training in whistleblowing and safeguarding adults, and were able to tell us what they would do if they had any concerns about the people who used the service.

Procedures were in place to manage people’s medicines safely and to control the risk of infection.

There was enough information in people’s care records to guide staff on the care and support needs required. People and their relatives were involved and consulted (where appropriate) about the development of their care records. This helped to make sure, wherever possible, the wishes of people who used the service were considered and planned for. The care records showed that risks to people’s health and well-being had been identified to help eliminate risk. The staff we spoke with had a good understanding of people’s individual needs and the support they required, and we found that care was delivered consistently by a team of workers who knew how to support people and meet their assessed care needs.

We saw that arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

There was flexibility and choice at mealtimes. People told us they enjoyed the food provided at Appleton Lodge and we saw that mealtimes were a relaxed and social occasion with good interaction between people. Specific dietary requirements such as sugar free or soft foods were available as required. Staff were aware of people’s dietary needs.

We saw that systems were in place to monitor the quality of the service provided. To help ensure people received effective care, checks were undertaken by the management of the home and there were opportunities for people to comment on the facilities and the quality of the care provided. Records showed that systems to manage complaints, incidents and accidents were managed well and measures put in place so that they were less likely to reoccur.

We undertook this visit to see if concerns found on our previous inspection in June 2013 had been addressed.

We spoke with ten people who lived in the home and four relatives or friends. All of the people we spoke with who lived at the home said they were happy living there. Comments included: “It’s a lovely place to be.” “It’s a good place to live and I’ve got some friends here. We all get along fine” and “I like my room and I like sitting with people and having a good old natter.” Visitors we spoke with thought the home was a good choice for their friends or relatives. One visitor said “We were nervous about X coming to live here, but she’s happy now and we can’t fault the place.”

We looked at the medication procedures and the staffing levels and saw that inprovements had been made in both areas.

Our observations, documentation we reviewed and the staff we spoke with assured us that the home had made significant improvements to the care it was providing. People were experiencing care and support to meet their needs. Staff also said that they had confidence in the manager and that the improvements would continue.

During our visit we spoke to three people who lived in the home. They were all very happy with the care and support that they were receiving. One told us; "They are all very nice here - the place is lovely and clean." Another person told us; "My room is very good - they moved it around to make it safer after I had a fall."

We spoke to three relatives. One told us; "The manager is wonderful, so kind, welcoming and reassuring. She is perceptive of my mum's needs." The other relatives we spoke to raised concerns about the staffing levels.

We spoke to five members of staff, three of whom raised concerns about the staffing levels. We looked at the staffing levels and concluded that they were not sufficient all of the time.

We looked at four care plans and had concerns about the way that people were being cared for and how this information was recorded.

We looked at the medication procedures and had concerns about the safety and security measures in place.

We looked at the complaints procedure and saw that it was clear and that staff understood how to respond to complaints.

This was the first Care Quality Commission inspection visit since the service was registered in October 2011.

We spoke with six people who used the service, two visiting relatives and three members of staff. People told us they were very happy with their care and were happy living at the home.

All the people we spoke with were positive about the service they received. Some of the comments were: “They (the staff) really care about me,” “They (the staff) most definitely know all my likes and dislikes,” ”It couldn’t be better” and “I feel loved. “

The relatives we spoke with were all positive with regards to the care their family members received. Some of their comments were: “I see the staff treat everybody with respect,” “It feels like an extended family,” “It’s absolutely wonderful here” and “I have no worries what so ever.”

Staff told us that people’s privacy and dignity was respected and personal choice was always encouraged. They told us that a lot of activities were provided and the home had a “Lovely, family atmosphere.” “One person said “The reason I come to work here is because the staff are very caring.”