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 due to our inspection activity only looking at specific quality statements. 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. Not enough improvement was made during this inspection and the provider remained in breach of legal regulation

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty. This inspection was to review the concerns we had previously identified at our last inspection in March and April 2025 following which the provider was served a warning notice. During the inspection process we were not assured when speaking with leaders they understood what improvements they were working towards. Leaders were unable to tell us what was cited in the previous warning notice, therefore, could not tell us what and where improvements had been made. Leaders had failed to make sufficient improvements to ensure they were completing effective quality assurance checks to monitor topical cream administration, care plans and people’s daily care tasks. These concerns were raised at our last 2 inspections. Where shortfalls were not identified by leaders within the home, operations leaders also did not identify these concerns when they carried out their audits of the service. This meant we could not be assured leaders at all levels were aware of what improvements were needed to ensure people received safe care and treatment. Since our last inspection there had been 2 staff meetings dated 15 May 2025 and 4 June 2025. There had been no nurse meetings since our previous inspection to the current inspection. Despite asking for, we found no evidence of communication between leaders and staff about how improvements would be made, who would be responsible together with a timescale for when the improvements would be made. This meant we could not be assured where improvements had been identified by CQC, these would be actioned. Failure to ensure the quality of care is good overall for the last 4 years demonstrates the management and leadership is inconsistent.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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 maintain consistent and accurate governance records which placed people at increased risk of harm. Leaders failed to complete effective quality assurance checks in order to drive continuous improvements. We reviewed daily walkaround, handover and resident of the day documents. We also reviewed daily flash meeting documents. During November 2025 there were 8 days of absent flash meetings documents. There were 7 days in November when the resident of the day documents were not completed, 0 documents had been completed fully. Resident of the day is where staff review a specific persons care needs and preferences. No explanation was offered as to why there were missing documents and this meant people’s care needs were not reviewed and updated fully. Handover documents were not consistently completed, and we found sections which had missing entries. These included the resident of the day, recorded bowel movements, low food and fluid intake. We could not be assured all information relating to service user’s needs were being communicated effectively between the staff team to ensure good continuity of care. An example of this was where a person had a low fluid intake, information was not shared in the handover document to ensure the person was monitored and staff were aware they may need to provide additional support. This meant the service user may be at risk of dehydration. This is a repeated concern from our last inspection.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.