Apple Tree House Residential Care Home Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of a legal regulation in relation to staffing.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety. Staff did not always investigate and report safety events. Lessons were not always learnt from incidents and events or used to continually identify and embed good practice.

Reporting mechanisms were in place for accidents and incidents, and some accidents and incidents had been reported. However, we could not be assured all accidents and incidents were reported. This placed people at risk of harm. Analysis of accidents and incidents did not take place. This meant the service was not able to monitor themes and trends and learn from these. There was no established mechanism for learning to be shared across the service. Action was taken to understand why a person had become distressed or why an incident occurred and what could be changed to prevent further occurrences.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was a collaborative approach to people’s care. Systems were in place to ensure people’s individuals needs were known and understood when transferring between services. Hospital passports were in place should people need to go to hospital.

People were consistently supported when they were distressed. Care plans were in place to support people to have a good day, and strategies were in place to prevent distress. Reactive strategies were available and followed by staff.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There were clear processes safeguarding systems in place to protect people from abuse. Staff were trained on safeguarding and were very confident action would be taken if concerns were raised. People’s sexual health and sexual needs were considered and safely supported. People had access to others outside of the service with who they could raise concerns about their safety. One person told us they felt safe and were “happy” with they way they were treated. When asked if they thought their relative was safe one relative said, “Yes, I do .”

The provider did not always work well with people to manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had individual risk assessments appropriate to them and the activities they undertook. When people’s needs changed, they were re-assessed. However, we were not assured that these risk assessments were reviewed in a timely manner when incidents or accidents occurred. Individual risk assessments for prescribed paraffin-based skin products were not in place. This meant people were placed at an increased risk of harm in these circumstances.

People were supported and empowered to take risks in areas they wanted to and to enhance their lives.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People had been consulted about the environment to ensure adaptations and reasonable adjustments could be made to meet their individual needs. People’s individual sensory needs had been considered. There were adaptations and reasonable adjustments made to enhanced people’s quality of life. People were able to feel relaxed when at home. Appropriate checks and maintenance had taken place. Personal emergency evacuation plans (PEEPs) were in place. However, these were not immediately available in the event of an emergency. We discussed this with the registered manager who made the appropriate arrangements.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support and development. Staff worked together well to provide safe care that met people’s individual needs.

Not all staff had received regular refresher training. Monitoring of staff training had not taken place. Work was ongoing to consolidate information about staff training to ensure appropriate training was taking place and staff received regular refresher training as required. However, this had not yet concluded or been embedded. People told us staff knew how to care for them safely. However, staff told us they did not have enough time to do the training they had been allocated. One staff member said, “It’s a struggle to fit this in at work. I’ve said I can’t do this at home, but we don’t always get the chance at work.” Another staff member commented about the training, “It’s hard to get done, you don’t have the time.”

Whilst one person told us there were “always staff around”, people, relatives and staff all told us there wasn’t enough staff. They all said this had impacted on people’s ability to access the community. For example, staffing rotas showed one staff member twice a week was allocated to take people swimming. However, this meant only three people were able to attend the swimming baths at those times. A person told us they had been unable to go out the previous week due to staff issues. Staffing rotas showed that when staff were absent due to sickness these shifts weren’t covered. A staff member said, “We have been short-staffed. I’m hoping there will be enough staff soon. A few [people] have been missing out on activities because there’s not enough staffing, and it always seems to be the same [people].”

Staff were recruited safely and received supervisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Cleaning schedules were in place and completed. Staff were appropriately directed which cleaning products to use, and cleaning equipment was clearly colour-coded to the particular task. The environment was clean and tidy. Staff were knowledgeable about IPC and used appropriate PPE when required.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff had received medicines training. However, competency checks on their ability to administer medicines had not taken place. This placed people at risk from receiving incorrect medicine administration. Individual flammable risk assessments for paraffin-based skin products were not in place. Medicines audits took place regularly. However, they had failed to identify the concerns found during our inspection visit.