Apple Tree House Residential Care Home Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified one breach of legal regulation in relation to governance. Quality assurance systems were not robust or consistently used to drive improvement at the home. Aspects of record keeping required improvement and formal staff support systems, such as supervision and training, were not consistently completed to promote continual improvement of the service. However, staff spoke positively about the management team, they felt supported and said there was a positive culture at the home. The acting manager was working to make improvements and was responsive to feedback. The service worked in partnership with other organisations to support people and there were systems in place to support workforce equality, diversity and inclusion.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The acting manager told us they promoted an open culture and staff told us there was always someone available if they need advice. One staff member said, “Someone is always available if I need clarity.” Other staff commented positively on the culture of the service and told us, “I think it’s very positive. Everyone seems happy, the place has a warm, friendly vibe. Staff are willing to help. It’s good.” The acting manager told us they were keen to make improvements and develop the service.

Whilst the acting manager and deputy manager were able to describe some actions they planned to take to make improvements to the service, there was not a clear strategy in relation to this, to ensure the team had a shared direction and vision.

Staff spoke very positively about the acting manager and deputy manager and said they felt well supported in their role. They told us the acting manager and deputy were approachable and one commented, “The managers are just great.” The acting manager acknowledged that they were still learning, as this was their first management role. They didn’t yet demonstrate confident understanding of all aspects of best practice and the provider's policies. However, they were keen to continue developing their experience and skills. They had recently joined the local authority’s mailing list for social care provider forums, held to develop knowledge and skills in the sector. The acting manager told us they hoped to exchange ideas and best practice in this forum in the future.

At the time of our site visit the manager registered with CQC was no longer working at the home, so there was an acting manager in place. The acting manager had some support from the local authority and a consultant working in an advisory capacity. The acting manager had not received an appraisal and there were gaps in their training. More time and support was needed for them to continue developing their experience. They were though very knowledgeable about the people supported, committed to making improvements and responsive to feedback.

Staff told us they would be confident about speaking up if needed and felt supported by the managers to do so openly. One commented, “Our priority is ensuring these guys get the best service and achieve the best outcomes they can, so I would always speak out.” The acting manager told us whistleblowing was discussed at interview and they encouraged staff to speak to them if they had any concerns.

Processes were in place to guide staff on how to raise concerns. There was a whistleblowing policy which had been updated in the last year.

The acting manager told us how staff were treated fairly. Staff spoke about equality and diversity within the staff team and felt supported.

The provider had systems and policies in place to support workforce equality, diversity and inclusion. Recruitment processes included equal opportunities monitoring data, health declarations and working time directive information. We noted though a number of staff were overdue their equality and diversity refresher training.

Staff understood their roles and responsibilities. One commented that their role was to support people to live a great and meaningful life whilst supporting people’s choices and decisions. They told us managers were always asking for ideas to improve the service. The acting manager told us they were aware of the need to implement and embed good audit systems and evidence lessons learned from incidents or concerns. At the time of our assessment, these audit systems weren’t consistently applied, so knowledge of best practice in this area needed to be improved.

We identified a breach of regulation in relation to governance. Systems and processes to assess, monitor and improve the quality and safety of the service were not operated effectively. A range of audits, governance and oversight systems had been put in place, but they had not been used effectively to identify issues and take action to improve. They had not identified some of the concerns found during this assessment. Where audits had identified a concern, action plans were not always formulated to address the concern. Where action plans had been implemented, these were not always robust and had no clear timescales for completion. There was no effective overview or review of accidents or incidents, to identify themes and any lessons that could be learned. There was no record of any complaints about the service since 2016, so it was not clear how any concerns raised may have been dealt with. Feedback was gathered from staff, but there was no record that the results of survey feedback had been analysed and used to make changes. The provider’s training and supervision policy was not consistently applied and oversight of this was not robust. The service was working towards a local authority improvement plan which started in March 2024, but was not yet fully completed at the time of our site visit. The service employed a consultant to support the manager and assist with service improvement. However, there was no audit or report from their visits, to help drive improvement from their visits. They explained they were working towards the local authority’s improvement plan. The business continuity plan was last updated in 2021. It did not include important contacts and specific events which may require action to keep people safe.

People were supported to regularly access community facilities and engage in community-based activities. This included cafes, swimming and discos. Two people had voluntary work at a charity shop and one helped to run a monthly film night at the local church. Relatives also confirmed the service worked in partnership with other agencies to ensure people got the support and healthcare they needed. For instance, one relative provided an example where a health review prompted the diagnosis of a new health condition for their loved one.

Staff confirmed they worked in partnership with other professionals to meet people’s needs where appropriate, such as where people had specialist healthcare input. Staff said they were kept informed of appointments and updates, so they could ensure they supported people appropriately. Comments included, “We have diary of appointments and consultation forms in individual files with updates, handover notes and other staff to liaise with. From my experience these are always completed.”

There were a number of health and social care professionals involved in people’s care. One visiting professional told us, “The staff are very supportive, kind and welcoming. Apple Tree is always clean and the cooking smells divine. Management are always approachable, I would give it 10/10 and would recommend.” The local authority were working closely with the provider to monitor improvements at the home and this work was on-going at the time of our assessment. Subsequent to our site visit, the local authority confirmed further progress had been made.

Care plans contained records about the involvement of other professionals to support good outcomes for people. For example, the service had worked in partnership to explore the reduction of psychotropic medication for one person. Systems were also in place to ensure people were supported to access the community and activities of their choosing. The acting manager had recently joined a forum for care home managers in the area and hoped to gain knowledge and develop relationships with others in the sector.

Staff and management did not demonstrate examples of innovation or learning from best practice. The acting manager was aware of the need to implement a system to support with learning lessons from incidents and feedback. Staff also told us Apple Tree House was a good place to work and they felt supported to develop their skills and bring ideas.

There was limited evidence of innovation or a systematic approach to continuous improvement. The local authority service improvement plan was discussed in staff meetings, but discussion was reactive and no clear action plans were created from these meetings. Lessons learnt, themes and trends from incidents and feedback were not routinely discussed in staff meetings.