Applegarth Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

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

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.

Care and support were not always planned and delivered in a way that reflected people's current needs, preferences and circumstances.

Care records did not always contain complete and relevant information about people's lives, needs and preferences. Some aspects of care, including people's emotional wellbeing and religious, spiritual and cultural needs, had been recorded as “Not applicable” without explanation. This meant important information about how people wished to live and be supported was not always clearly documented.

People's experiences of care were mixed. Whilst some people spoke positively about the support they received and told us staff were helpful, others described inconsistent experiences and some people told us the quality of support depended on which staff were on duty.

Despite these issues, we observed examples of good practice where staff demonstrated person centred approaches in their day-to-day interactions with people.

People did not always experience continuity of care and support. Systems were not always effective in ensuring staff had the information they needed to provide coordinated, consistent care.

We identified inconsistencies in moving and handling guidance within care records and in practice. In addition, 2 people raised concerns about moving and handling practices during night shifts. Records relating to people's nutrition and hydration were also not always accurate or reflective of people’s needs. We also observed variations in how a person was supported, which contributed to them becoming unsettled and distressed. This demonstrated that agreed approaches to care and support were not always consistently understood, recorded or implemented.

Despite these concerns, there were examples of continuity being maintained. The service had a stable workforce and people were supported to access healthcare services when required.

The provider supplied appropriate up-to-date information in formats that were tailored to individual needs.

Care plans documented people’s communication needs which helped support effective understanding and engagement.

An effective system was not fully in place to ensure people, relatives and others were listened to, involved in decisions about the service and able to influence improvements.

No complaints had been logged. However, discussions with people, relatives and staff, together with our review of records, demonstrated that concerns were being raised within the home but were not consistently recognised, actioned or monitored to support learning and improvement. This reduced assurance that people's views and experiences were being used to improve the quality and safety of care.

Although systems were in place to gather feedback, we received mixed feedback from people and relatives regarding opportunities to share their views. Whilst some described receiving feedback forms or invitations to ‘residents and relatives' meetings,’ others told us they had not been asked for feedback or could not recall being involved.

The registered manager told us they were reviewing how feedback was obtained and intended to expand the use of telephone calls to relatives, following an approach used by the lifestyle and leisure team to gather feedback from relatives who were unable to attend meetings.

People were able to access the care, support and services they needed.

People had access to a range of healthcare professionals, including specialist nurses, physiotherapists, dietitians, speech and language therapy, when required. Face-to-face pre-admission assessments were completed before people moved into the home to help ensure the service could meet their needs.

Systems were not always effective in ensuring people consistently experienced positive outcomes and received care that met their individual needs. This was due to concerns regarding the accuracy, completeness and consistency of care records.

Care plans and risk assessments did not always reflect people's current needs, circumstances and desired outcomes. This reduced assurance that staff had access to accurate information to deliver consistent, person-centred care and increased the risk of inequitable experiences and outcomes for people living at the home.

People's experiences of care were mixed. Whilst some people and relatives spoke positively about the care provided and the positive impact living at the home had on their wellbeing, others described inconsistencies in the quality of support they received. Some people told us they felt staff were caring and attentive, whilst others felt support depended on which staff were on duty.

However, we heard positive examples of improved outcomes for some people. A person described how living at the home had helped them regain confidence, improve their wellbeing and rebuild their life. People also had access to healthcare professionals when required.

A system was in place to support future planning and ensure people's wishes, preferences and choices about their future care were considered.

Records included information relating to future care planning, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and details of Lasting Power of Attorney (LPA) arrangements where these were in place.

We saw opportunities to further strengthen future care planning through the use of a structured system to identify and monitor people who may be approaching the end of their lives.