Applewood Support Limited

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 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 the legal regulation in relation to good governance. There was a lack of consistent robust managerial oversight of risk management, safety and quality of the service provided. The provider had some systems and processes in place to check the safety and quality of the service, but these did not always have the desired outcome of identifying where improvements were needed.

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.

All staff spoken with were positive about the provider and business development and operations manager, they told us they felt supported and worked as a team to give consistency in care to people.
 

Not all leaders understood the context in which the provider delivered care, treatment and support. They did embody the culture and values of their workforce and organisation. And, whilst leaders had integrity, openness and honesty, they did not always have the skills, knowledge and experience to lead effectively.

Since our last inspection, the provider had reduced their office based working days and delegated tasks to other staff. Where this had happened, improvement was needed to ensure those staff were capable in fulfilling tasks delegated to them. For example, where medication audits had been delegated, checks on EMARS had been undertaken but where missed medication was identified and the reason given as ‘dose not available; there was no further action recorded on what was done about this. Where leaders undertook spot checks on care staff, sometimes those leaders’ lack of knowledge meant fully effective spot checks could not take place to ensure care staff had their skills effectively checked. The business development and operations manager had identified some staff were not aware of leader’s specific roles and responsibilities and had undertaken work to raise awareness of this.

Staff felt leaders were compassionate and inclusive toward them and others. One staff member described the provider as ‘very kind and supportive’. Another staff member told us they felt ‘teamwork was very good’.
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The provider had processes to support staff to speak up. These included Monday morning ‘flash’ meetings, supervision meetings and team meetings. The provider also had technology in place to enable two-way communications with staff. All staff spoken with felt they could ‘speak up’ if needed. For example, if they were concerned about anything. One staff member told us, “The management team are approachable and would listen to any concerns.”

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 described a culturally diverse workforce who worked together as a team and respected one another. Where individual staff had identified needs, reasonable adjustments were offered and put in place to support staff in their job role.

The provider did not consistently 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.

Processes were not always in place to ensure the delivery of safe care. For example, there was no effective processes to ensure potential risks of harm to people had been identified, mitigated and communicated to staff.

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

The provider had not ensured effective processes were in place to identify, manage and mitigate risk associated with people’s care. This meant staff did not have the information they needed to provide safe care.

The provider and business development and operations manager had not ensured staff had the skills and knowledge needed to undertake delegated tasks, including assessing people’s needs and care planning.

The provider and business development manager did not have sufficient service oversight to ensure tasks delegated to staff were either completed, or effectively completed, and followed the provider’s policies and procedures and best practice.The provider’s audits and checks to monitor the quality and safety of the service were not always effective. For example, audits of care records had not identified 1 person’s care records had not been reviewed following a change in their needs. Checks of medicine management had not identified staff had not completed body maps to inform staff where on a person’s body a prescribed cream should be applied. This was a requirement of the provider’s policy and procedure.

Where people and relatives had raised concerns with the provider, they were generally satisfied issues had been resolved. However, we found improvement was needed to ensure concerns were fully followed through with staff. For example, where a concern had been raised about 1 staff member, it had been recorded ‘investigation to be completed.’ The business development and operations confirmed this had not happened and there was no record the concern had been addressed with the staff member, this meant risks of reoccurrence had not always been reduced.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

Whilst the provider had a desire to focus on continuous learning, innovation and improvement across the organisation, in practice this did not always take place.

The provider’s systems and processes did not always enable them to have the oversight to identify where improvements were needed, so that lessons could be learned and continuous improvements made. For example, we saw 1 staff member’s file contained no previous employment reference. Whilst this reference had been chased, we were told that the business no longer existed. This meant chasing the request was not purposeful, but no alternative reference had been sought.