CQC report explained · a nursing home
What the CQC found at Applegarth Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, March 2024
Applegarth Nursing Home was rated Requires Improvement; inspectors found risks in records, staff training, medicines and management systems.
This was an unannounced focused inspection on 8 and 16 January 2024. Inspectors looked at Safe, Effective and Well-led because of concerns about restrictions on people and staff training for distressed behaviours. They spoke with people, a relative and staff, observed care, and checked care, medicines, staff and management records.
The home had enough staff, and people said they felt safe and comfortable. Staff were described as kind, calm and respectful. People received support with food, drinks and health appointments, and staff worked well with other professionals.
However, risk assessments and care records were incomplete or not regularly reviewed. Staff training for specialist needs was not clearly demonstrated. Medicines records and safeguarding processes were not always properly completed. Management systems were not effective enough to identify and correct these problems. The overall rating changed from Good at the previous inspection in 2019 to Requires Improvement.
Kind and calm care
People said staff were kind and made them feel safe. Inspectors saw staff supporting people in an unrushed and engaging way.
“People said they felt safe and comfortable at the home. They commented staff were "nice" and treated them with kindness.” from the report
Enough staff
Inspectors found there were enough staff on duty. Staff checked people in bedrooms regularly when some people could not use call alarms.
“The provider ensured there were sufficient staff on duty.” from the report
Food and drink support
People were offered choices and received support suited to their dietary needs. Mealtimes were described as gentle and unrushed when people needed physical help.
“People were offered a choice of dishes at each mealtime and dined when they were ready.” from the report
Working with health professionals
Staff helped people access health services and worked with occupational therapy and community health services.
“Staff collaborated with health professionals such as occupational therapy and community health services on behalf of people.” from the report
Risk management
seriousRisk assessments did not set out clear actions to reduce risks, and some were not reviewed regularly. One manual handling assessment was incomplete and conflicted with specialist advice.
“The failure to identify, monitor and manage risk placed people at potential risk of harm.” from the report
Staff skills and training
seriousThe provider could not show that staff had the specialist training needed for the people living there. Nursing staff skills and competence were not properly recorded or reviewed.
“The provider lacked a comprehensive system of recording the skills and competence of nurses.” from the report
Management oversight
seriousImportant audits were stored on a computer that only the absent registered manager could access. This meant senior managers could not reliably check safety and care quality.
“The failure to ensure a demonstrable and effective system was in place to monitor the quality and safety of the service was a breach of Regulation 17” from the report
Restrictions and consent
seriousA small number of people had been restricted without the required legal framework or staff training. The report says one previous restriction on access to the community was no longer happening.
“The management team had not always acted within the principles of the Mental Capacity Act so a small number of people had been restricted without a legal framework or training by staff to do so.” from the report
Medicines records
needs fixingFridge temperatures were not recorded consistently or correctly. There were also no body maps or written instructions for applying some prescribed creams and ointments.
“The record of daily temperatures for the medicines fridge were not being recorded consistently or correctly.” from the report
Safeguarding follow-up
seriousThe safeguarding log had not been updated since August 2023, despite later incidents, and referrals had not always been made to the local authority.
“Safeguarding referrals had not always been made to the local authority.” from the report
- 01What risk assessments and care plans have been completed or reviewed since the inspection, and how do you check that staff follow them?
- 02What specialist training do staff receive for neurological, nursing and distressed behaviour needs, and how do you confirm they are competent?
- 03How are medicines fridge temperatures, topical creams and medicines audits now recorded and checked?
- 04How are safeguarding incidents recorded and referred to the local authority?
- 05How can senior managers access audits and care records when the registered manager is away?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected, and the overall rating used the previous ratings for the key questions not inspected. This explanation was written from the published report of 6 March 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2019
Applegarth Nursing Home was rated Good, with major improvements since the previous Requires Improvement rating.
Inspectors made an unannounced visit on 19 February 2019. They spoke with people living in the home, a relative, staff and managers. They observed care, looked around the building and checked care, medicine, recruitment and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safer recruitment, improved medicines checks, detailed care plans and kind, respectful care. People were supported to make choices and remain as independent as possible.
The rating improved from Requires Improvement at the previous inspection, published on 5 April 2018. Inspectors said significant improvements had been made in safety and management, and that the provider's action plan had been followed.
Safe staffing and recruitment
Inspectors found enough staff to meet people's needs safely and without rushing. Recruitment processes had improved and appropriate checks were completed.
“There were enough staff to meet people's needs in a safe and unhurried manner.” from the report
Kind and respectful care
People told inspectors they felt cared for and respected. Staff took time to speak with people and promoted dignity and independence.
“There was a relaxed atmosphere in all three units and staff took the time to speak with people in a dignified and friendly manner.” from the report
Personalised care
Care plans included people's needs, wishes and preferences. Staff adapted communication and offered activities and choices.
“Care plans were detailed and contained specific information about the support the person needed.” from the report
Improved management
The home had made significant improvements since the previous inspection. Audits, feedback and reflection were being used to improve care.
“The staff and management team had made significant improvements since the last inspection.” from the report
Records needed updating
needs fixingSome capacity assessments and best-interest decisions were more than a year old. The manager agreed these should be reviewed.
“Some capacity assessments and best interest decisions were over a year old.” from the report
One end-of-life plan was not specific
needs fixingMost detailed end-of-life plans recorded people's wishes and medical interventions, but one plan needed follow-up.
“Some people had detailed end of life care plans in place which outlined their wishes and relevant medical interventions, however one was not specific.” from the report
Food preferences
minorA varied diet was provided, but one person said the food was not always to their taste. The manager said the menu would be discussed again.
“A varied diet was provided although one person said it wasn't always to their taste.” from the report
Low survey response
minorThe home sent surveys to people and relatives, but few responses were received. It was trying other ways to gather views.
“Surveys were sent to people and relatives however the response rate was low so new methods of seeking people's views were being tried.” from the report
- 01How often are capacity assessments and best-interest decisions reviewed, and how will you make sure none become out of date?
- 02How do you record and check each person's end-of-life wishes and medical treatment preferences?
- 03How can residents influence the menu if meals are not to their taste?
- 04What methods do you now use to gather feedback from residents and relatives when survey responses are low?
- 05What changes from the previous inspection are now checked through audits or other monitoring?
This was an unannounced scheduled inspection covering all five CQC areas and both the premises and care provided; the report does not describe it as a focused inspection. This explanation was written from the published report of 15 March 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Applegarth Nursing Home
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- March 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2019Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- April 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2017
Registered with the Care Quality Commission on 2 May 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
9 live-in carers within about an hour of Cumberland
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 9 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.