Applecroft Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to the governance at the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff worked well together and there was an effective team approach. The registered manager worked with staff to develop a shared direction. Meeting minutes demonstrated they guided and encouraged staff to meet certain expectations. Staff told us people were at the centre of the care provided.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People were positive about the management of the service. The registered manager was approachable and accessible. Throughout our assessment they were open and transparent and responsive to our feedback, taking some immediate actions. They were keen to develop and improve the service. A visiting professional told us they had seem improvements in the way the service was led under the current management team. The service was small and the registered manager knew people well and was focused on providing personalised care.

The registered manager had put some improvements in place since coming into post. However, aspect of their oversight and governance had not identified some gaps in practice. Feedback indicated the management team were often required to cover other roles, which meant they couldn’t always focus on leadership and strategic tasks.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider had a whistleblowing policy which managers had recently re-issued and discussed with staff. The registered manager had an open-door policy and staff felt able to share any concerns. One staff member said, “I would raise concerns, if I had any.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had an equality, diversity and human rights policy in place and staff undertook relevant training. Feedback from staff indicated they were treated fairly and the registered manager worked towards an inclusive approach.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider failed to ensure effective systems to assess, monitor and improve the quality and safety of the service provided were in place. Whilst the provider and the management team undertook various audits, governance systems were ineffective because they had either not highlighted or fully addressed the concerns we identified during the assessment. We identified issues in relation to the safe administration of medicines, aspects of risk management, working in line with the MCA and some environmental issues.

The provider had rolled out a new schedule of audits to be undertaken over a 12-month period. However, this did not include any IPC audits. The provider undertook regular medicine audits; however, these had not identified the issues we found in relation to aspects of staff practice.

The registered manager had already developed an improvement plan, with various actions identified for ongoing improvement. Some of these had been completed but others remained in progress.

The provider had not ensured CQC were notified of all incidents as legally required. Whilst we had been advised of several incidents, we identified 2 events which we had not been notified about. The registered manager submitted these when we brought this to their attention.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The registered manager worked in partnership with partners such as the local authority and health professionals to share information. Whilst they worked with people and relatives to seek feedback, information about any actions taken in response was not clearly shared or displayed.

People’s access to and input from the community was an aspect of the service which needed to be strengthened.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The registered manager was keen to learn and develop the service. However, they had not always accessed external support and training on offer to develop best practice. The provider had introduced a new electronic system to help streamline care planning. In response to our feedback, they sought guidance from other professionals to help with improvements.

Whilst improvements had been made in some areas, overall progress was slow and inconsistent. This was the 5th inspection where we found a repeated breach of regulations relating to the governance of the service. Whilst the provider had taken some actions, these were not fully embedded or effective, this indicated lessons had not been fully learned to make and sustain the necessary improvements.