Appleby Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had sufficient staff to provide all planned care visits. People told us no visits had been missed and that staff normally arrived on time. The service recruitment practices were safe. However, necessary pre-employment checks had not been completed for staff who had transferred to this service from a failing provider. The provider took action to address this issue following feedback. People generally had capacity to make decisions for themselves. However, where concerns were identified in relation to people’s capacity the assessments completed were generic in nature and did not relate to specific decisions in line with best practice. Staff understood local safeguarding procedures and were confident any issues reported to managers would be investigated and addressed. Risk assessments had been completed but did not always provide staff with specific guidance on the action they should take to mitigate identified risks.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were confident the provider had appropriate systems to ensure visits were not missed and knew how to report any concerns or complaints to management. People said, “I’ve only called the manager if they’re running late. I’ve got a pleasant response” and “I can ring the manager at any time. If she’s not available she always calls me back.”

Staff understood the importance of sharing details of any concerns or informal complaints with managers to ensure people's needs were met. Staff said, “If unavoidable delays occur, we have procedures to notify clients and management. Any missed or late visits are documented and reviewed to prevent recurrence.”

The provider had systems in place to ensure any accidents or incidents that occurred were documented and investigated.

All care staff wore uniforms and had photo identification badges to enable people to confirm their identities during initial care visits.

Staff were provided details of how to locate and access people’s homes using a secure digital system.

When people first started using the agency information from the local authority and any previous providers was used to help ensure the service had sufficient information about people's needs to support them safely and in line with their preferences.

People felt safe with their care staff and told us, “I feel safe”, “Safe? Yes. Absolutely. It’s because they know what they’re doing” and “[My relative] is happy and safe. The staff are kind and caring.” All staff wore uniforms and had identification badges which helped people identify their carer during initial care visits.

The staff team and the deputy manager had a good understanding of local safeguarding procedures. Staff said they would always report incidents or concerns. Their comments included, “I would contact the safeguarding team immediately and report the case as well as informing the management” and “If something wrong happens in the field with any of the service users, I immediately report to the management so they can take action accordingly.”

The service did not have robust systems in place for assessing people’s mental capacity in accordance with the Mental Capacity Act (MCA). Where assessments of people’s capacity had been completed, these were generic in nature and did not relate to specific decisions.

People were confident their staff knew how to protect them from harm and that equipment to support their mobility needs was used safely.

Staff shared information effectively through daily care records to ensure all staff were aware of any changes in people’s needs or associated risks. Staff told us, “Everyone has a care plan and risk assessments and they are up to date” and “[We] are trained in risk assessment to identify any potential risks to the client’s safety and wellbeing.”

People’s care plans did include risk assessments, however these documents were not as person centred as their care plans. Risk assessments did not always provide staff with clear guidance on what they should do to mitigate known risks. Following feedback the provider reviewed and updated risk assessments so that they were more person centered and provided more guidance for staff.

No one reported having experienced missed care visits and people consistently reported their staff normally arrived on time. People told us, “I have 3 visits a day. Morning, afternoon and evening. It’s very good. The carers are on time, stay for the time they should, do what I need and very obliging”, “They stay for their allotted time unless I don’t need anything more. I control it. They’d willingly stay if needed” and “Carers arrive on time. They’re brilliant. They stay for the time they should.” We visited one person in their home when we saw staff had arrived on time and stayed for the planned duration of the care visit. People were also confident staff were skilled and well trained. One person told us, “I think the staff are sufficiently trained and know what I need. If my moods are not great the carers do breathing exercises with me.”

Staff told us the service was well staffed and that planned visit times were appropriate to enable people’s care needs to be met. Their comments included, “The rota is sent, and we get it in advance, so we know what it is we are doing and when. We are ok with this and can plan our days, so the rota is fine”, “We have enough staff. Some clients are double handed and we always have 2 staff” and “They have enough staff. They give us enough time to do our allocated tasks, some time spent with clients and breaks for our lunch and take some rest.” No staff member reported having missed a planned visit and the deputy manager told us, “We’ve never had any missed visits. I think we have an hour leeway either side. If [Staff] could not get there within the hour we would call [the person] and inform them.”

Necessary pre-employment checks had been completed for all staff directly recruited by the service. Where staff had been recruited from overseas under the current visa scheme, police checks in the staff members country of origin had also been completed. However, Disclosure and Barring Service checks had not been completed for a group of staff that had been supported to transfer to Appleby Lodge from another care provider in Cornwall. References had been collected from the previous employers and evidence of DBS checks by the previous employer were available. Following feedback additional necessary DBS checks were requested. We noted that people’s planned visit times on the service’s rotas were variable, exposing people to the risk of inconsistent visits each day. However, call monitoring data showed care staff had made changes to their visit schedules to improve the consistency of people’s visit times. Although this limited the impact of the variations in planned visit times it created additional risk as staff were not always completing visits in the planned sequence. Managers recognised improvements to the service’s visit scheduling systems were necessary and a new IT system was being introduced to resolve these issues.

People told us their staff used PPE appropriately during care visits and helped with cleaning tasks as required. People’s comments included, “Staff work in a clean and tidy way” and “They leave my home tidy and wear gloves.”

Managers and staff had a good understanding of infection control measures. Spot checks completed by the deputy manager ensured staff were using PPE appropriately when required.

Staff had access to good supplies of Personal Protective Equipment (PPE). We observed this equipment being used appropriately during our home visit.

Most people told us they managed their own medication without help from their support staff. Where people did receive support with the medication, they were confident this was done safely. One person told us, “Tablets are in a blister pack. They know exactly what to give me and make sure I take them.”

Staff understood how to support people with their medicines and how to document this information. One staff member told us, “They provide us proper training on how to give the medicine to residents.”

The service had appropriate systems in place to support people with their medications. All care plans included details of people’s current medications and, where support with medicines was provided, Medicines Administration Records (MAR) had been completed. The deputy manager completed regular medicines audits. Where issues were identified in relation to the quality of support staff provided with medications appropriate additional supervision and training was provided.