Appletrees 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 inspection we rated this key question requires improvement. At this inspection the rating has remained the same. The service was in breach of legal regulation in relation to good governance.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager and staff had a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Staff spoke positively about the support they received from the registered manager and described them as having an “open office” should they wish to share anything. One staff member told us, “This is a nice place to work, and we are well supported by the registered manager. I can go and talk to them, and they will be fair and helpful.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. The registered manager was compassionate about their role and sought advice from external professionals and other managers when they needed help. However, leaders did not always correct staff during meetings when suggestions were made which did not follow best practice medicines guidance. For example, during a nursing meeting a staff member had suggested an action when checking controlled medicines which did not follow best practice guidance, this was agreed by leaders and documented in meeting minutes for staff to follow . The registered manager told us they had spoken with staff and leaders to ensure they were now all aware of how to follow the recommended guidance.

The service had some systems in place to gather feedback from people, relatives and staff, however these required further strengthening to ensure where actions were needed, these were recorded and acted upon. There were no recorded resident or relative meetings, although people and relatives told us they would approach the management team with any concerns. The registered manager understood their responsibilities under the duty of candour. The duty of candour is to be open and transparent, and it sets out specific guideline's providers must follow if things go wrong with care and treatment.The provider had a whistleblowing policy in place.

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 service promoted an inclusive and fair culture, and all staff we spoke with told us they were treated equally and were happy to work as a team. One staff member told us, “We work as a team, we have an allocation list and usually work in pairs and help each other”. The provider had an equality and diversity policy in place and staff had received the relevant training.

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 management team failed to complete effective quality assurance checks to ensure continuous improvement. Audits had not identified gaps in service user’s daily checks, incorrect information in care plans, and did not highlight where areas of improvement were needed. Area manager audits were incomplete, and where actions were needed, these had not been identified and followed up. For example, it had been identified the weekly medicines audits was not being reviewed regularly, no actions were set to review and monitor this. IPC (Infection Prevention and Control) concerns had not been identified with the service kitchen audits. This placed service users at increased risk of harm and a repeated concern from our last inspection. We met with leaders of the service to share our findings for them to start making improvements.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. Staff worked closely with healthcare professionals, and we observed several different professional’s visiting the service during our onsite visits. One regular visiting professional told us, “I don’t hear people unattended, or distressed, staff interact nicely with people. The manager and administrator do a good job, where there have been issues, they address these and engage well”. The majority of people and relatives told us they were updated regarding changes to people’s healthcare needs. Where people required additional support when they became anxious when staff needed to complete healthcare tasks, relatives had been involved in the process which offered reassurance.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research. Although there have been some improvements made since our last inspection further improvement was needed to ensure the service had embedded a robust governance system which identifies shortfalls of safe care delivery and treatment.