Apple Tree House Residential Care Home Limited

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• 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

People felt safe and confirmed staff were available when they needed them. This was supported by our own observations, as we saw staff delivered care which was respectful and unhurried. Staff were confident about raising any concerns, but a number of them required safeguarding training to ensure their knowledge about the correct procedures was up to date. Staff were attentive to people’s safety, however improvements were required to risk assessments, to ensure staff had the correct guidance to follow. Staff supervision and training was not always completed in line with the provider’s policies. Although we found some areas of concern at this assessment, until we have assessed more quality statements in the ‘Safe’ key question, the rating for this key question remains the same.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe and would be able to talk to staff about any concerns. Comments included, “I definitely feel safe, any member of staff will help you with any problems.” However, systems in place to manage safeguarding concerns were not fully robust so we could not be assured people’s experience would be consistent, or appropriately managed.

Not all staff had received required safeguarding training, so we could not be confident all staff had enough knowledge in this area. The staff we spoke with had an understanding of safeguarding and knew how to access the provider’s policy and procedure. They were able to discuss personal values which were appropriate for their roles and responsibilities.

People appeared to be comfortable living at the home, and in the company of staff supporting them. People confidently approached staff by their names and were engaging and relaxed in their presence.

Safeguarding procedures were in place, but some improvements were needed to ensure they were consistently followed and opportunities to learn from incidents were maximised. Investigation reports were available for some concerns raised, including initial fact finding, supporting evidence and outcomes. However, there was limited evidence of analysis of concerns and lessons learned in order to support service improvement. There was also no evidence that lessons learned were shared with the staff team. Out of 16 staff, 4 required safeguarding training and 7 were overdue safeguarding training. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found DoLS applications had been made where required. However, some records in relation to the MCA were not robust. The provider was working to improve these. Further information about this is noted in the Consent to Care section of this assessment.

People felt safe and relatives were happy with the care provided, including support with any health risks. One relative told us, “[Name] is well looked after, we are kept well informed by staff.” Another told us their relative was “Very stable” which they felt indicated they were getting appropriate care because their loved one’s behaviour was an indicator if things weren’t working well. One relative told us about a potential safety risk which occurred but said this was promptly rectified once it was raised. Whilst we received generally positive feedback in this area and people we spoke with felt involved in decision making about risk, we could not be assured people's experience was consistent because there was a lack of recorded evidence about this.

We could not be fully assured of the team's knowledge in relation to risk management because there were some gaps in care plan and risk assessment documentation. Staff told us they routinely involved a range of professionals to support people. The acting manager gave us an example where one person wanted to manage their own finances and look after their own bank card. They looked at ways to do this safely with the person and their social worker. However, there were no risk assessments in place to support this and make sure everyone was clear about the arrangements to mitigate potential risk. Care plans were being reviewed and staff told us they could see the positive improvement in the plans that had been worked on so far.

We observed staff supporting people safely. For instance, staff used equipment safely and as intended. Staff spoke with people before, during and after any tasks. They checked with people about their safety in a respectful, kind way. We also observed staff encouraging people to complete tasks independently. For example, to make food and drinks, and tidy their rooms. Staff were responsive to people's needs.

Risks to people were not always assessed or managed safely, because records were not always accurate or complete. They were not sufficiently detailed or personalised. This included care plans and risk assessments relating to health conditions such as epilepsy, diabetes and finances. They did not always provide sufficient guidance for staff to manage risks to people. Not all staff had received specific training about epilepsy and diabetes. There was limited recorded evidence about how people or their families had been involved in planning their care or managing risk. However, the service was in the process of reviewing and updating all people’s care records.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us there were enough staff available. One person said, “Staff come reasonably quickly when I use my buzzer” and told us they wanted to complete the hoist training with staff and were able to do so. Another said, “Staff are caring and kind.” A relative told us, “Staff are well trained, we have no concerns.”

Staff felt there were enough staff on shift. They told us, “We absolutely have got enough time to sit and get to know people” and “We are never short staffed. The manager and deputy would always step in, we have never not been able to provide the care.” The manager told us they had bought in extra staff where needed and were currently fully staffed. Although staff felt supported, training and supervision was not completed in line with expectations, and the acting manager did not demonstrate knowledge of the provider’s supervision policy.

We observed calm and relaxed support during the visits. People's requests were acted on promptly. Staff had time to sit and chat with people, and engaged in meaningful interactions with them. Staff took a genuine interest in people's days, and their views and interests. Staff were seen encouraging people to take part in activities.

Staff were not receiving regular 1:1 supervision to develop their skills and practice. There had been some infrequent supervisions around specific topics, but no regular individual supervisions as outlined in the provider’s policy. Not all staff had completed mandatory training in supporting people with a learning disability and autism. Five staff had completed this training but 14 staff were overdue. There were also significant gaps in staff training relating to safeguarding, MCA and equality and diversity. The lack of oversight in relation to training and staff supervision was part of the breach of regulation in relation to governance, referred to in the well-led section of this report. Staff were recruited safely. All required checks were made prior to staff starting to work at the home. Rotas mostly reflected the staffing levels that were assessed to be required by the provider.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.