The inspection took place on 15 May 2018 and was unannounced.

Appley Cliff 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.

Appley Cliff is a care service which provides accommodation for up to 13 people who have a physical disability. At the time of our inspection there were 12 people living at the service.

There was a registered manager at 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.

The last comprehensive inspection of this service was in May 2016 when the service was rated ‘Good’. At this comprehensive inspection, we found the service was not meeting all the legal requirements and was rated ‘Requires Improvement’.

When we completed our previous inspection on 10 May 2016, we found concerns relating to the management and recording of topical creams, and gaps in the previous employment of staff. At this inspection, we found that these specific issues had been addressed, however we identified other concerns over the safe storage of people’s medicines.

People were not always treated in a kind and caring manner. We observed some interactions between people and staff, which did not respect people’s dignity.

Quality assurance systems were not always robust enough to identify and monitor some environment risks, and risks to people. These had not been used effectively to identify concerns we found during the inspection, or drive improvement in the service.

Although people’s bedrooms were decorated to each individual’s taste and contained personal possessions and photos, we identified certain areas of the service were in need of refurbishment and redecoration. Some areas of the service posed a risk of infection and contamination due to ineffective cleaning on damaged surfaces and areas.

People’s care plans contained individual information, however some areas did not always reflect people’s needs.

People felt safe at the service and staff were aware of their responsibilities to identify, prevent and report abuse. People’s rights were respected and the principles of the Mental Capacity Act 2005 were being followed appropriately.

People were encouraged to make decisions about how their care was provided, and staff encouraged people to be as independent as possible in their day to day lives.

Effective recruitment procedures were in place, and there were enough staff available to meet people’s needs.

Staff received regular and meaningful supervision and staff had an opportunity to voice their individual views.

Plans were in place to deal with foreseeable emergencies such as fire risk; staff we spoke with said they had had received training to manage such situations safely.

People were supported to maintain their health and well-being. Staff supported people to attend

appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink.

There was a complaints policy in place and people felt able to raise concerns.

There was an open and transparent culture. Visitors were welcomed and the registered manager sought and acted on feedback from people.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

This inspection took place on 10 May 2016 and was unannounced. Appley Cliff provides accommodation and personal care for up to 13 people who have a physical disability. There were 12 people living at the home when we visited.

There was a registered manager at the home. 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.

With the exception of prescribed topical creams medicines were managed safely and people received these as prescribed.

Appley Cliff had a strong, person centred culture. People were supported and encouraged to be as independent as possible and able to live the lifestyle they chose. Staff and management were fully committed to finding ways to improve the service.

People and external health professionals were positive about the service people received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people were conducted regularly. People were supported to enjoy activities of their choosing.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people’s legal rights was followed correctly. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Staff offered people choices and respected their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The registered manager and provider’s representatives were aware of key strengths and areas for development of the service and there were continuing plans for the improvement of the environment. Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.

We have made a recommendation about the management of prescribed topical creams.

Appley Cliff can accommodate up to 13 people. At the time of our visit we were informed that there were currently 12 people living at the home including two people who were staying on respite care. We looked around the home which was clean and free of unpleasant odours.

All the room were single occupancy with hand basins with ceiling hoists and had access to communal toilets, showers and bathroom. We saw that individuals had personalised their room with photographs, books, TV’s and pictures. All the corridors were wide enough for wheel chair access and there was a lift so people could access the first floor.

When we last visited we were advised that that the home was due to start a major refurbishment to provide ensuite facilities to each of the bedrooms. We were informed that this had been delayed and was due to start in the summer of 2014.

During our visit we spoke with two people who used the service and six staff including the registered manager via the telephone and the deputy manager. We spent time observing how staff interacted and supported people. We saw staff treat people in a sensitive, respectful and professional manner.

On arrival we were informed that there were twelve people living at Appley Close and the other bedroom was currently being used for respite.

We looked around the building which was clean and free from unpleasant odours. The bedrooms all had ceiling hoists and had been decorated in the colour schemes chosen by the people who used them. The rooms were personalised with choices of bedding with photographs, books, TV’s and pictures. All the door ways and corridors were wide enough for wheel chair access, and there was a lift so people could access the first floor.

During our visit we spoke with three people who used the service and four members of staff (including the registered manager). We also spoke with a visitor. We spent time observing how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

All the people we spoke with said they were happy living at Appley Close. One person said the staff look after you and were helpful, and another told us that the staff help them to do what they want to do. We spoke with a visitor who said they were very happy with the home and that it was clean and tidy.

People using the service were able to tell us about their experiences and we also spoke with relatives and health professionals. We spent some time in the home’s communal areas observing people and staff. Interactions were warm and friendly with staff clearly having a good knowledge about the people they were caring for.

Everyone we spoke with confirmed that their privacy and dignity were maintained at all times. People also said that they were able to make day to day decisions such as what time they got up and how and where they spent their time. People gave us examples of when their choices had been respected. People also told us they had a choice about what they had for their meals. They were very positive about the meals provided at Appley Cliff.

People said that they had no concerns about how their personal care needs were met. They told us that if they were unwell then staff would contact doctors for them. People said staff were available when they needed them and knew what care they required.

People told us that lots of activities were provided including minibus outings to various places chosen by them. People told us they felt they were safe living at Appley Cliff.

People and visitors said that they felt staff were available whenever their relative needed assistance. They also said that staff were very pleasant and had the necessary time to meet people’s needs. People told us that call bells were promptly answered.

People told us that there is a monthly meeting for residents where they could discuss things such as menus and activities.

People and visitors said that if they had any concerns or complaints they would raise these. People gave an example of when they had raised a concern and the action taken by the manager to resolve the issue.

Visitors were positive about the way the home met the needs of their relatives. They confirmed that they were kept informed about any illness or untoward incidents. Relatives said that if they had any concerns or complaints they would raise these with the staff or the manager.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met.