Applegarth Nursing 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 assessment, this key question 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 provider’s quality assurance systems lacked robustness, as they either failed to identify concerns or did not take appropriate action when issues were detected. As a result, the provider was found to be in breach of the legal regulation regarding good governance.

This service scored 46 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Although steps had been taken to rebuild trust and better communication, these efforts needed further work and required sustained focus to embed a positive and inclusive culture.

We received mixed comments from staff about the culture at the service. One staff member said, “I am treated well,” while another said, “There is inconsistency in how staff are treated.” A further staff member said, “Management are approachable, and I have no issue going to them, but the general work environment is not nurturing and not always supportive.”

The provider did not have consistently inclusive leaders. Management had not always embodied the culture and values of their workforce and organisation.

While leaders possessed the necessary skills, knowledge, experience, and credibility to lead effectively, this was not consistently reflected in practice. Staff feedback was mixed, some praised the high standards of the management team, while others identified areas requiring improvement. A recurring theme among staff was the need for better communication. The management team responded to our feedback and produced a communication plan to address these issues.

In contrast, feedback from relatives was generally positive. One relative commented, “The management team are professional and not condescending.”

People felt if they spoke up, the management team would respond. However, staff did not always feel confident they could speak up or that their views would be heard. There were differing perceptions among staff regarding how their input was received. While some felt supported, others reported their suggestions were not consistently acknowledged or acted upon by management. One staff member commented that improvements could be made by “giving staff the opportunity to discuss what improvements could be made, not just the staff meetings where management like to complain.” This lack of alignment between management’s intentions and staff experiences reduced the effectiveness of open communication and limited overall staff engagement.

An effective system was not fully in place to ensure an inclusive and fair culture. Staff shared mixed feedback about their involvement in service development, with some feeling supported and others reporting that their views were not acknowledged or acted upon. Staff stated that communication across the service was inconsistent, particularly between night and day staff, which impacted continuity and staff morale. Supervision and annual appraisals had not been carried out as planned, and staff lacked consistent opportunities for reflective practice and professional development.

The provider did not have clearly defined responsibilities, roles, or systems of accountability to support effective governance. There was a lack of robust oversight, which contributed to continuing breaches of the regulations.

Although audits and checks were in place, they did not identify or address issues such as medicines management and record keeping. Additionally, a legally required notification had not been submitted to the Care Quality Commission. We are addressing this matter outside of this assessment.

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 timely information and learning with partners or collaborate for improvement.

Some healthcare professionals commented that communication could be improved. This was discussed with the provider for them to address.

Care records were in the process of being fully reviewed to make sure they were up to date, legible and accurate when sharing details between services.

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 and effective practice.

The provider had failed to learn lessons from the previous inspection, and there were continuing breaches of regulations. Safety concerns were identified during the first day of inspection and raised with the management team. However, by the second day, some issues remained unresolved. These ongoing issues reflected a lack of effective governance and oversight. It demonstrated the systems in place were not sufficient to ensure compliance or drive sustained improvement.

Areas discussed during the site visit were promptly added to the location’s action plan, and the registered manager kept the Care Quality Commission (CQC) updated on the progress of these actions. While these steps were positive, the improvements now need to be embedded into practice and monitored over time to ensure sustained impact.