Applegarth Nursing Home

Updated 6 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, a Specialist Professional Adviser and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Applegarth Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Applegarth Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and care professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people and a visiting relative. We observed interactions between people and staff and looked at the condition of the building.

We spoke with 12 staff including the deputy manager, nurses, care workers, cook, maintenance, leisure and administrative staff.

We reviewed a range of records. This included 5 people’s care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

Updated 6 March 2024

About the service

Applegarth Nursing Home is a residential care home providing personal and nursing care to up to 53 people. At the time of our inspection there were 31 people using the service.

The care home accommodates people across three separate wings, each of which has separate facilities. These include a unit for older people living with dementia, a unit for people with neurological conditions and a unit for people with complex care needs.

People’s experience of using this service and what we found

The provider's quality assurance systems were not effective and had not addressed the clear shortfalls in records and checks. Senior management were unable to access audits so could not be assured key aspects of service delivery were being safely and effective met.

Risk assessments were not always in place to show staff how to manage potential risks to people’s well-being. Some people’s care records were incomplete and were not reviewed at regular intervals. There was no audit evidence available to show if these were kept under critical review nor checked for quality or relevance.

The provider had no demonstrable evidence to show staff had relevant training in order to meet the specific conditions of people who lived there.

People were not always supported to have maximum choice and control of their lives and staff had not always assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. A small number of people had been restricted without a legal framework or training by staff to do so. This was being addressed.

Medicines management and storage records were not always completed in line with good practice. Local safeguarding processes had not always been followed when incidents had occurred.

People said they felt safe and comfortable at the home. They commented staff were “nice” and treated them with kindness. Staff supported people in an unrushed, calm and engaging way.

There were enough staff to support people. Staff displayed caring values and good teamwork. They were respectful of people and their colleagues.

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

Rating at last inspection

The last rating for this service was good (published 15 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about restrictions on people and lack of staff training in supporting people with distressed behaviours. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Applegarth Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management and good governance of the service at this inspection.

We have made a recommendation about oversight of the provider’s safeguarding system.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.