This inspection took place on 24, 25 and 28 January 2019 and was unannounced.

Applewood is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Applewood Care home provides care for up to 39 older people living with differing stages of dementia. There were 37 people living at the home on the first day of our inspection, with one person receiving end of life care. All accommodation is provided in a two-storey building, within a rural village on the outskirts of Basingstoke.

At our last inspection in May 2016 we rated the service to be Outstanding. However, we were not provided with evidence to support the continued rating of Outstanding. At this inspection we found evidence to support the rating of Good.

Since our last inspection in May 2016 there had been a change of manager, which had had an adverse impact on staff retention and morale. The previous registered manager left the home in September 2018, shortly followed by a number of experienced care staff. The provider had been recruiting to fill these vacancies since. The new home manager had worked hard to rebuild staff morale and recruit new staff members. The home manager had almost completed the process to become the registered manager.

At this inspection we found the home was consistently well-managed by the home manager who provided clear and direct leadership. Staff consistently told us the management team had created a supportive environment where their opinions and views were discussed and taken seriously, which made them feel their contributions were valued.

Quality assurance systems monitored the quality of service being delivered, which were effectively operated by the management team, to drive continual improvement in the service.

The home manager collaborated effectively with key organisations and agencies to support care provision, service development and joined-up care, for example; local GPs and community mental health and nursing teams.

People experienced care that made them feel safe and were protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations were carried out, in partnership with local safeguarding bodies.

Risks were assessed, monitored and managed effectively. Staff were aware of people’s individual risks and how to support them to remain safe.

There were sufficient staff to respond quickly and provide safe and effective care to people. The home manager operated a robust recruitment process, based on relevant pre-employment checks, which assessed the suitability of candidates to support older people and those living with dementia.

People's dignity and human rights were protected, whilst keeping them and others safe. Staff supported people who experienced behaviour which may challenge sensitively, in accordance with their positive behaviour support plans.

People received their prescribed medicines safely, from staff who had their competency to administer medicines assessed annually. People’s medicines management plans were reviewed regularly to ensure continued administration was still required to meet their needs.

High standards of cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection. Staff followed the required standards of food safety and hygiene, when preparing, serving and handling food.

Staff had an effective induction, ongoing training and support to maintain necessary skills and knowledge to support people effectively.

People were supported to eat and drink enough to protect them from the risk of malnutrition and dehydration. Risks to people with more complex nutritional needs were promptly referred to relevant dietetic specialists.

Each person had an individual health action plan which detailed the completion o

This inspection was unannounced and took place on the 4 and 5 May 2016.

Applewood is a care home which provides residential care for up to 39 older people living with a range of medical conditions including diabetes and those living with Alzheimer’s and Dementia.

The care home comprises of two floors situated within its own secure grounds and garden in a residential area in a village on the outskirts of Basingstoke town centre. The home has 37 single rooms with two double rooms available, two communal lounges with televisions and colourful furniture and a quieter lounge adjacent to the reception area. Meals were served at people’s choice in their rooms, lounges or a dining room situated in a conservatory which looked out directly onto the gardens which homed chickens to provide interest and fresh eggs. At the time of the inspection 37 people were living at the home.

Applewood has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 was committed to and passionate about staff training and development. The registered manager used creative, proactive and innovative ways of developing staff that enabled them to apply their learning in their practice. Staff, family and healthcare professionals were encouraged to take part in Virtual Dementia Tours which provided them with the physical and sensory deprivation which can be experienced by those living with dementia. The learning from this training was used to inform staff’s interaction styles with people. This ensured that staff had the skills and understanding to deliver outstanding personalised, quality care.

The service provided care and support to people enabling them to live fulfilled, active and meaningful lives. The provider and staff were motivated to ensure that people were provided with the opportunity to participate in daily activities and homely tasks to retain their independence. The use of activities as a life enriching experience was understood by all the staff at Applewood. All staff, not just those involved in the delivery of care, participated to ensure people were fulfilled and had an active and interesting life which promoted their independence. Staff were highly motivated to develop close relationships with the people they were supporting. Staff used verbal reassurance and touch with people to ensure that people were involved and encouraged to participate in conversations and were able to engage with staff.

Relatives of people using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people. People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely. There were sufficient staff employed to ensure that people’s individual needs were met.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as a fire. Fire drills were documented, understood by staff and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Senior staff responsible for administering medicines had received

We spoke with eight people who lived in Applewood. We also spoke with one relative and five members of staff, including the manager.

All of the people we spoke with who lived in the home told us that they were happy. They all said they had “no complaints”. Three of the people we spoke with told us how they would complain. They said they were confident that any issue would be quickly sorted out. Every person we spoke with said that the staff were very good.

People were encouraged to make decisions about their care and treatment. One person we spoke with told us how they could get up and go to bed when they liked. They said they “didn’t have to do anything they didn’t want to.”

People had sufficient to eat and drink. The people we spoke with told us they enjoyed the food. One person said “the chefs are excellent”.

There were appropriate arrangements in place for the ordering, storing, administering and disposal of medication.

Complaints were recorded and responded to in line with the home’s policy.

We spoke with two people who lived at Applewood and a relative. We also spoke with a volunteer and five members of staff, including the managers. The home was clean and tidy with a pleasant smell. All of the people we spoke with told us that improvements had been made. They all said that Applewood was a happy, friendly place to work or live.

Care plans were clear and detailed with up to date risk assessments. We looked at six care plans and saw that the support delivered was in line with the care and support required.

There were sufficient, appropriately qualified and skilled staff on duty and we were told by the people who live in the home that they were ”well looked after” and that “nothing was too much trouble for the staff”. The staff were well supported with regular supervisions and appraisals. The training was up to date.

The provider had an effective system to monitor the quality of the service provided.

During our inspection we spoke to four people. Two people told us the staff were good. One of those people said when they used their call bell the staff came as quickly as they could depending what they were doing. Two people said the staff were alright.

Two visiting community nurses told us the staff sought their advice and followed treatments plans but that they did not always ensure dressings were applied and monitored appropriately. One of the nurses also, when we asked, commented on the unpleasant odour in the home.

The residents told us they liked the staff who they said were kind and caring.

We observed the staff interacting with the residents and offering people choices.

Relatives told us they appreciated the care the residents received and the staff were good. One relative was disappointed that, despite calling ahead, their family member was not ready to go out and that this resident's hair needed more care.

The staff said they were generally well supported in their roles and they tried to do their very best to care for the residents.