Applegarth Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question requires improvement. At this assessment, this key question has changed to inadequate. This meant people were not safe and were at risk of avoidable harm.

The provider had previously failed to comply with legal requirements regarding safe care and treatment. At this assessment, not all necessary improvements had been achieved, and the provider continued to be in breach of this regulation.

Medicines were not safely managed. The environment was not fully monitored for safety or fully protected from the risk of infection.

This service scored 38 (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 did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

During the first day of inspection, we identified several safety concerns and promptly raised them with the management team. However, by the second day, some of these issues, such as unsecured doors to areas requiring restricted access, remained unresolved. Lessons had not been fully learned from our previous inspection, and while some action had been taken, further work was required to ensure compliance with the regulations.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services.

Assessments were completed before admission to the service and staff gathered information about people's needs prior to them receiving care and support. However, staff had not always received the required training in place to fully support people when they initially moved in, including dealing with aggressive behaviour. The provider was working to address any training deficits before people moved into the home and had implemented further training.

While staff aimed to improve people’s lives and uphold their right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, there were areas where this was not consistently achieved. Although concerns were generally shared appropriately, there was one instance where a safeguarding investigation had not been reported to the Care Quality Commission. In addition, there were shortfalls relating to infection control, medicines management and the premises, which impacted the overall safety and quality of care.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found they were following the principles and worked with the Local Authority to manage this.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe and supportive. There was a lack of information available to staff where people had equipment in place to manage risks relating to their skin integrity. Care plans did not include sufficient detail, such as the correct settings for specialist mattresses, and this information was not routinely monitored. As a result, staff did not always have the necessary details to deliver safe and effective care in this area. The management team planned to take action to address the issue.

In addition, we identified shortfalls regarding the assessment of risk relating to infection control, the environment, and medicines management. As a result, risks in these areas were not always identified or addressed effectively, which impacted the safety and quality of care.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities, and technology supported the delivery of safe care. Secure doors were often unlocked, including places where chemicals were stored. Wardrobes were not always attached to walls. Visitors were not always asked to sign in which meant the provider could not consistently monitor who was entering the premises or ensure appropriate oversight of access to the service.

Some refurbishment had taken place; however, further work was required to ensure the environment was safe and well maintained. This included replacing flooring that posed a potential trip hazard.

The older section of the home, which originally accommodated older individuals including those living with dementia, was not purpose-built to meet their complex needs. Its narrow corridors and smaller rooms limited accessibility and did not support best practice in dementia-friendly design. At the time of this inspection, the provider was planning extensive refurbishment of this area and nobody was living there.

The provider did not always make sure staff received effective support, supervision, and development. Teamworking was not always effective, and poor communication between staff, including management impacted the delivery of safe care that met people’s individual needs. Staff lacked consistent supervision and annual appraisals, undermining professional development and service quality. The provider was in the process of addressing this. However, this was still outstanding from our last inspection.

The provider had established a mandatory training programme; however, gaps were identified, and additional training was subsequently arranged to address these shortfalls, this included specialist training to support staff with specific healthcare needs.

The provider took steps to ensure there were enough staff. Although due to sickness or holidays on a small number of occasions, there had been shortages. Any staff vacancies were now filled and the provider had bank staff to support any future shortages. Safe recruitment practices were in place; however, we found interview records lacked detail.

The provider did not assess or manage the risk of infection. They did not detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Some equipment, including bathing equipment, heavily stained toilets, beds, and chipped paintwork needed to be addressed.

Although staff had received training in infection prevention and control, and policies and procedures were in place, these measures had not been effective in practice, as significant concerns were evident in relation to infection control.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Our assessment identified multiple concerns that compromised the safety and effectiveness of care delivery.

There were gaps and omissions in medicine records, and protocols for ‘as required’ medications, often used for pain relief, were not consistently in place. This lack of guidance left staff without clear instructions on when and how to administer these medicines, increasing the risk of inappropriate or delayed treatment.

Furthermore, thickeners, used to modify food and drink textures for individuals with swallowing difficulties, were not securely stored, posing a potential hazard. Staff competencies in administering medicines had not been recently assessed, contrary to best practice standards. This oversight undermined confidence in the safe handling of medication and highlights a critical need for improved oversight and training.