Applegarth Nursing Home

At our previous assessment, we identified 2 breaches of the regulations relating to safe care and treatment and good governance. This assessment was undertaken to check the provider had followed their action plan from our last assessment and to confirm they now met legal requirements. The assessment was also undertaken in response to concerns about people's care and support. We found insufficient improvement had been made and identified continuing breaches of the regulations relating to safe care and treatment and good governance.

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.

Leadership and governance arrangements were not sufficiently robust to ensure risks were identified, monitored and addressed effectively. Improvements identified at previous inspections had not been fully embedded or sustained and systems for monitoring quality, learning from incidents, safeguarding concerns and complaints were not always effective. Staff did not always feel supported in their roles and some said they would welcome a more visible management presence within the home.

We identified concerns relating to staff training and support, nutrition and hydration, medicines management, environmental and fire safety. Care planning and risk assessments were not always accurate, complete or up to date and did not consistently provide staff with clear guidance to support the safe delivery of care.

Since people with a learning disability were living at the home, we assessed the service against the principles of Right Support, Right Care, Right Culture (RSRCRC). These principles aim to ensure people with a learning disability and autism are supported to have choice, control, independence and access to their local community. We found some aspects of the guidance were being met. People were supported to access activities, maintain social connections and engage with the local community. However, concerns relating to care planning, risk management, governance, the application of the Mental Capacity Act 2005 and inconsistencies in people's experiences of care meant we could not be assured the principles of Right Support, Right Care, Right Culture were fully embedded across the service.

Despite these concerns, we found some positive practice. Infection prevention and control standards had improved since the last assessment. People had access to healthcare professionals when required and the service benefited from a stable staff team.

Since the safe key question has remained rated inadequate, the service has been placed into special measures. The purpose of special measures is to ensure services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and establish a timeframe within which providers must improve the quality and safety of the care they provide.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.