Apple Tree House Residential Care Home Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People felt they had choices and could make decisions about their care and day to day lives. However, some records in relation to this, and records required to demonstrate adherence to the Mental Capacity Act, were not consistently robust. Work was underway to address this. People’s needs were assessed, involving relevant professionals where appropriate.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they were involved in the development of care plans and reviews of their care. One relative said, “The care plan was written when [Name] moved into Appletree House, and is reviewed annually. I am confident that [Name] would be able to raise the alarm if their care was not meeting their needs.”

Staff told us people’s needs were assessed. They told us they were not directly involved in reviews, however they said it was an open discussion to raise any issues or any changes they had noted in people’s needs, to inform the review. The acting manager told us about their approach and said, “It’s about comprehensive assessments and getting information from all people involved in that person’s care. It’s about knowing the person.”

Systems were in place to assess people’s needs. Admission assessments were completed and retained on file. Care plan reviews were completed monthly by people’s keyworker. Local Authority review documentation was also available to refer to. Care plans were written from the person’s viewpoint with lots of information about their likes and dislikes. Where external professionals were involved, there were supporting plans and reviews in place. People’s communication needs were also detailed with their care plans with scripts for staff to follow where appropriate. People’s needs were assessed but there was work ongoing to make sure care plans and risk assessments were consistently robust and appropriately updated, as referred to elsewhere in this report.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People felt they had choices and could make decisions. People told us they could choose what activities and what level of support they required daily. Comments included, “I get up when I want”.

Staff had a good understanding of the importance of gaining consent and offering people choices. Their comments included, “It is their choice, I would encourage this as much as possible” and, “Speaking and talking to people throughout always works better if you have a good rapport with people.” However, record keeping in relation to consent, mental capacity and best interests decisions was not always robust and some staff did not have up to date MCA training. Work was ongoing to make improvements in this area and more staff training would help to support this work.

Records did not always evidence how people were involved in decisions and there were not always records to show how decisions made in people’s best interests had been taken following the principles of the Mental Capacity Act and were the least restrictive options. The acting manager had started reviewing and implementing up to date mental capacity assessments, in accordance with the Act. This had been done with people’s involvement and their level of engagement had been recorded. These were informative and demonstrated understanding of MCA. Some people had the support of advocacy services, for independent support with expressing their views. We recommend the provider reviews best practice in this area and continues work to update all people’s mental capacity assessments and best interests decision records in line with legislation and best practice.