Archived: Apple Tree Care

Updated 19 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The inspection took place on Monday 07 December 2016 and was unannounced.

The inspection was undertaken by two adult social care inspectors. Prior to this inspection we reviewed information we held about the service, such as notifications we had received from the registered provider and information we had received from the local authority. We looked at the provider information return [PIR] previously submitted to the Care Quality Commission [CQC] by the registered provider. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with two people receiving a service, five relatives of a person receiving a service, two care workers, one house keeper and one team leader. We also spoke with the registered manager.

We looked at records which related to people’s individual care, such as the care planning documentation for three people and other records associated with running a residential care service. This included four care workers files, other recruitment and training records, the care workers rota, records of audits, policies and procedures and records of meetings. We observed daily activities in the home including the administration of medication and the assistance people received with moving and handling.

Updated 19 February 2016

The inspection took place on the Monday 7 December 2015. The inspection was unannounced. The previous inspection was completed in January 2014 and the provider was compliant with the outcomes assessed.

Apple Tree Care is a care home service without nursing. They provide long term accommodation for up to twenty older people who require nursing or personal care, some of whom may be living with dementia. At the time of our inspection there were twenty people receiving a service. The home is located just outside the City of York in the village of Strensall, with surrounding, mature landscaped gardens. Off road parking is available for visitors.

Apple Tree Care has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives spoke positively about the care they received. It was clear from talking to people and looking at care plans that care was person centred. People told us they felt safe and we found that staff knew how to protect people from avoidable harm.

Risk assessments and risk management plans were in place and they were regularly reviewed with people in line with their changing needs and documented in their care plans.

The service had a robust recruitment policy. We observed that there were adequate numbers of staff on duty; staff did not appear rushed in carrying out their duties. Care staff we spoke with told us they would always be happier with more staff so that they could spend more time with people.

The care workers knew the people and the people knew the care workers. We saw people responding positively, often smiling when staff approached.

Care workers were put through a robust recruitment, induction and training programme ensuring they were supported to have up to date skills to provide care and support to people.

The registered manager told us that training in end of life care was important and this would be completed for all staff by the end of January 2016.

Medication training was included as part of the induction process for staff. We saw medication was effectively administered with clear guidelines and methods of recording, administering and disposing of people’s medication. Medication was administered in a safe and caring way, people were involved in agreeing to the medication and a drink was always provided.

We observed some minor errors with medication. The registered manager told us and we saw these were picked up by audits and, where applicable, additional staff training was provided.

Care workers told us they felt well supported and we saw good communication and relationships between care workers, management, people who used the service and outside agencies such as the local authority and health workers.

The registered manager and staff had a good understanding of the Mental Capacity Act and explained how consent and capacity were considered during people's assessments and care planning. Training records also showed that staff had covered the Mental Capacity Act and Deprivation of Liberty Safeguards during their induction and ongoing training. The registered manager told us they were committed to supporting staff with any additional training to that staff understood their responsibilities and people's legal rights were protected.

People were encouraged to live as independently as possible and to make their own decisions. Where people did not have capacity, the correct processes were followed and measures put into place to ensure people received care that was in their best interest. Identified risks were managed ensuring that people could still live as independently as possible.

The home was welcoming and vibrant with a variety of activities on offer to help keep people engaged and happy. The registered manager had worked with the organisation since 1992 and had considerable experience in dementia related illnesses including training in ‘Dementia Care Matters.’ As a result of this experience the home had been decorated in bright colours and textures and work undertaken to make it ‘dementia friendly.’

We saw a range of regular staff meetings, supervisions, and resident meetings took place. There was evidence that meetings actively engaged with staff and people to share ideas, best practice and implement improvement, and that people’s feedback was listened to.

People told us that they were treated with dignity and respect. Staff understood why this was important to people who used the service and they provided positive examples of how this was put into practice, for example, by ensuring clothing and towels were available at bathing time and knocking on the door before entering a person’s room.

We saw that the register provider had good working relationship with external partner organisations. These included the local authority, GP’s, Healthwatch and the district nursing team.