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 assessment we rated this key question requires improvement. At this assessment 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 provider was previously in breach of the legal regulation in relation to governance. Sufficient action had not been taken to improve and the provider remains in breach of this regulation.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems were not always effective in creating and sustaining a positive culture that supported staff, promoted open communication and provided a clear shared direction for the service.

Some staff told us they did not always feel listened to or supported and described low morale within the service.

We received mixed feedback from people and relatives about the culture within the home. A relative told us, "I have no issues with the place at all, it is excellent." However, another person described the atmosphere within the home as "depressing" at times.

The provider told us they were exploring initiatives to improve staff morale within the home. The registered manager also explained that staff morale had been affected by increased scrutiny from external agencies.

The findings of our assessment did not demonstrate that leaders were capable and inclusive in providing effective oversight, support and direction for the service.

During the assessment, we identified a number of concerns across the service and continued breaches of the regulations. Despite previous improvement activity and action planning, a number of areas requiring improvement remained. This demonstrated that leaders had not established or maintained effective oversight systems to identify, address and sustain improvements, resulting in continued shortfalls in regulatory compliance.

We received mixed feedback from people, relatives, staff and external professionals regarding the visibility, effectiveness and support provided by leaders within the service. Some staff described feeling unsupported and disconnected from the management team. Staff also raised concerns about the visibility of the registered manager.

However, not all feedback was negative. Some staff described leaders as approachable and supportive. A staff member told us, "The management team is supportive, approachable, and listens to staff."

Staff did not always feel they could speak up and that their voice would be heard.

Whilst a system was in place to support staff to speak up; some staff told us they did not feel confident to speak up or raise concerns, because they were unsure if action would be taken or if they would be supported. A staff member said, "There’s no point (in speaking up) it’s a waste of time. We’re not motivated to do it as we have raised things before and nothing happens."

Work to promote workforce equality, diversity and inclusion was ongoing; however, staff feedback indicated further improvements were needed to ensure all staff felt valued, included and treated fairly.

The provider had a diverse workforce made up of staff from a range of backgrounds, experiences and roles. However, some staff raised concerns about fairness and consistency within the service. Comments included, "There's double standards" and "Not great, (culture) there’s favouritism of friends of management." Some staff also told us they did not always feel listened to or feel confident that concerns they raised would result in meaningful action.

Not all feedback was negative. Some staff told us they enjoyed working at the home and felt proud to be part of the team and found managers to be supportive and approachable.

Governance systems were not effective in assessing, monitoring and improving the quality and safety of the service.

This was the third consecutive assessment at which breaches of the regulations relating to safe care and treatment and good governance have been identified.

While quality assurance processes were in place, they were not consistently effective in identifying issues, monitoring performance or driving improvement to promote good outcomes for people. We identified continuing concerns relating to medicines management, the management of risk, medicines management, staff training and support, the maintenance of records and governance and oversight systems. In addition, the provider had failed to submit legally required notifications to CQC in relation to authorised Deprivation of Liberty Safeguards (DoLS) applications, which limited effective regulatory oversight.

Partnership working had supported some progress; however, improvements had not been fully implemented or embedded into practice.

At the time of our assessment, the home had been subject to the local authority's quality improvement process. The provider had received ongoing oversight and support from external agencies, including visits and action planning. Despite this level of support, concerns still remained at this assessment.

Systems to support learning, improvement and innovation were not effective.

The recurrence of concerns identified at previous inspections indicated sufficient learning had not taken place to achieve sustained improvements in practice. This was reflected in staff feedback, with 1 staff member telling us, "It's no different from the last inspection."

As a result, there was limited assurance that systems for learning and improvement were leading to lasting improvements in people's experiences and outcomes.