Applegarth Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question required improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

An effective system to assess people’s needs was not fully in place.

We identified gaps and inconsistencies in the assessment of moving and handling needs, behavioural support, nutrition and healthcare needs. Wound care assessments also lacked sufficient detail to guide staff.

Staff raised concerns about the care planning and assessment system. Comments included, "Nobody really understands it" and "The care planning documentation is not designed for us."

The provider had already implemented an action plan to review care plans and assessments, improve the quality of documentation and ensure records were accurate, up to date and reflective of people's current needs. This was still to be embedded.

We found positive practice in relation to assessing people's needs. Face-to-face pre-admission assessments were completed before people moved into the home to help determine whether the service could meet their needs. This helped support decision-making regarding admissions and the planning of care prior to people coming to live at the home.

An effective system was not fully in place to ensure care and treatment were delivered in line with current legislation and best practice guidance.

Records did not consistently demonstrate that care and support were provided in line with best practice guidance.

During our assessment, we observed inconsistencies in the way staff supported 1 person. This contributed to the person becoming unsettled and experiencing increased distress. We also identified an instance where moving and handling techniques were being used that had not been formally assessed and were not reflected within the person's care plan or risk assessments. In addition, 2 people raised concerns regarding moving and handling practices.

We also observed positive practice. Staff were caring in their approach and took time to engage with people, providing reassurance and support in a respectful way. During mealtimes, staff supported people in a calm and unhurried manner.

An effective system was not fully in place to ensure staff worked collaboratively with other teams and services to meet people's needs.

Staff did not always communicate concerns about people's health and wellbeing in a clear or structured way. There was limited evidence of staff using recognised approaches to identify, record and communicate signs of deterioration to healthcare professionals. A professional told us, "I will sometimes come in and they will say, 'they [person] are not right' but do not say what."

Following our assessment, the registered manager told us they would review the use of a recognised clinical tool for identifying and monitoring deterioration through the routine assessment of a person's observations and health indicators, to support timely escalation of concerns and improve communication with healthcare professionals.

A handover system was in place, and staff received a handover at the start of each shift to support continuity of care.

People's health and wellbeing needs were not always effectively supported.

We identified shortfalls in the management of medicines, nutrition, support for people's behaviours and the monitoring of healthcare needs. Care records did not always contain accurate, consistent or sufficiently detailed information to guide staff in meeting people's needs, responding to changes in their health or providing support in a consistent manner.

Despite the issues we identified, there were positive aspects to people’s care. There was regular involvement from health and social care professionals who attended the home on a regular basis to support people’s needs.

An effective system was not fully in place to monitor people’s care and treatment to continuously improve it. Audits and reviews were not consistently identifying or addressing gaps in care planning and delivery.

Systems for monitoring aspects of people's health and wellbeing were not always effective. For example, bowel monitoring information was not recorded in a format that supported easy review and trend analysis. Staff and a professional told us this made it more difficult to identify patterns and changes in people's health. In addition, some staff told us they were unable to take photographs of wounds and as a result, some wounds did not have photographs available to support monitoring and review. The registered manager told us photographs could be taken and would communicate this to staff to ensure this was understood.

Despite these issues, we observed positive interactions between staff and people. We also heard examples of how people's health and wellbeing had improved since moving to the home. A person told us, "I feel I can build my life back up. I am in a good environment, they are very empathetic and very observant. It's been so good coming here, I'm different again, it's been a positive experience. I'm full of praise for them."

Systems were not fully effective in demonstrating how people's consent was sought and how decisions were made in accordance with the Mental Capacity Act 2005 (MCA).

Records did not demonstrate that MCA principles had been consistently applied where restrictions were in place. We found limited evidence of mental capacity assessments and best interests decisions relating to the use of covert medicines, sensor alarms, bed rails, being cared for in bed and a locked bathroom. As a result, it was not always clear that these restrictions were the least restrictive option available or were being implemented in the person's best interests.

The registered manager told us they had been advised that where a Deprivation of Liberty Safeguards (DoLS) authorisation was in place, further MCA documentation was not required.

However, DoLS authorisations do not remove the requirement to undertake decision-specific mental capacity assessments and best interests decision-making. As a result, it could not be demonstrated that restrictive practices were being applied lawfully, proportionately and in accordance with the MCA.

The registered manager told us this documentation had previously been in place and would be reinstated.