Enter and view: Appletree Court Nursing Home

Healthwatch Barnet conducted a follow-up Enter and View visit to Appletree Court Nursing Home on 7 March 2017 to assess progress since an earlier inspection in November 2015. The visit took place shortly after the home had been acquired by the Maria Mallaband Care Group, resulting in significant organisational changes, new procedures and additional corporate support. 

Appletree Court provided nursing care for up to 77 residents and had 68 residents living at the home at the time of the visit. Management reported that the new ownership had introduced improved systems, including dedicated human resources, health and safety, training and quality teams, which staff generally viewed positively. A programme of improvements was also being planned, including refurbishment of bedrooms, communal areas and grounds, together with additional activity staffing. 

The home demonstrated good links with healthcare services. Residents had access to GPs, district nurses, physiotherapists, chiropodists and other specialist services as required. The home also participated in Barnet Council’s “Significant 7” initiative, which helps staff identify early signs of deterioration in residents’ health and respond appropriately. Independent advocacy support was available through a long-standing volunteer service, particularly benefiting residents living with dementia. 

Staffing was identified as the main area of concern. Although management reported that staffing levels were regularly monitored and additional bank staff could be brought in when necessary, Healthwatch received repeated feedback suggesting that staffing levels were insufficient to meet residents’ needs fully. Residents and relatives often described staff as rushed and overstretched, and some relatives felt this negatively affected the quality of care and relationships between staff and residents. 

Training arrangements were also highlighted as an area requiring further attention. While the home provided induction training, encouraged staff to gain qualifications and had invested in specialist training, much of the mandatory training was delivered through e-learning. Healthwatch expressed concern that completion of online training alone did not necessarily demonstrate practical competence and recommended that staff skills be assessed in real-world settings. 

The home provided a wide range of activities, supported by two activity coordinators. Activities included themed events, outings, celebrations and use of an on-site cinema room. However, some relatives felt there were insufficient activities for more independent and able residents, suggesting additional opportunities such as quizzes and board games. Management had already requested funding for an additional activities coordinator to expand the programme further. 

Feedback regarding food was generally positive. Residents and relatives reported satisfaction with meals, and the home had worked with Barnet Council’s quality team to improve the dining experience. Additional snacks and drinks had also been introduced, including overnight refreshments.

Residents and relatives were kept informed about developments following the takeover, and meetings were held regularly to discuss concerns and updates. Although people generally expressed satisfaction with the home, many reiterated concerns about staffing pressures and the impact this had on the resident experience. 

Overall, Healthwatch concluded that Appletree Court was undergoing a positive transformation under its new ownership and that management was enthusiastic about improving services. However, the report found that concerns about staffing levels and staff training remained unresolved and continued to affect day-to-day experiences for residents. 

Healthwatch recommended a further review of staffing levels, stronger assessment of staff competency following e-learning, and a review of whether the new learning and development supervision arrangements were sufficiently frequent and effective. The home accepted the recommendations and outlined measures already underway, including recruitment of additional staff, enhanced professional development arrangements and ongoing collaboration with Barnet Council’s quality improvement programmes.