Applewood Care Home

We found the following examples of good practice.

• During the outbreak, the provider ensured only people at the end of their lives received visitors indoors, in accordance with national policy.

• The provider had in place effective measures, to ensure when visits resumed, these were safe. Visitors booked an appointment and completed a form about their health prior to visits.

• Staff had designed and built a cleanable visiting ‘pod’ for visits within the service, for the safety of people, staff and visitors. There was also a summer house in the garden, which in addition to a gazebo had been used in the summer for visits to people.

• People were well supported by staff to have telephone and internet contact with their relatives. The service had four iPads, to facilitate contact.

• Staff ensured people’s welfare had been maintained and they had sufficient stimulation.

• Staff had used the Clinical Commissioning Groups (CCG's), 'COVID Oximetry at home service,' during the outbreak. Staff monitored and reported people’s oxygen levels to a 'virtual ward,' which enabled the early detection of deterioration in people and rapid intervention and treatment.

• Staff had supported people to uptake their COVID-19 vaccination.

• The service had ample communal areas, which were well used, to ensure people could socially distance.

• Processes were in place to ensure when the service resumed admitting people, they were admitted safely and self-isolated for 14 days, in accordance with national guidance.

• Staff had received relevant training in infection prevention and control and used the PPE provided appropriately.

• Staff and people had been tested for COVID-19 in accordance with national guidance.

• Staff ensured the service was regularly cleaned and the environment was adequately ventilated.

• The provider had processes in place to ensure vulnerable staff had been identified and supported appropriately. Changes had been made, to ensure staff staggered their break times and had access to sufficient space for their breaks to enable social distancing.

• Many of the staff were trained to work across more than one department, which meant they had able to cover other roles when colleagues were absent.

Applewood is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Applewood Care home provides care for up to 39 older people living with differing stages of dementia. There were 37 people living at the home on the first day of our inspection, with one person receiving end of life care. All accommodation is provided in a two-storey building, within a rural village on the outskirts of Basingstoke.

At our last inspection in May 2016 we rated the service to be Outstanding. However, we were not provided with evidence to support the continued rating of Outstanding. At this inspection we found evidence to support the rating of Good.

Since our last inspection in May 2016 there had been a change of manager, which had had an adverse impact on staff retention and morale. The previous registered manager left the home in September 2018, shortly followed by a number of experienced care staff. The provider had been recruiting to fill these vacancies since. The new home manager had worked hard to rebuild staff morale and recruit new staff members. The home manager had almost completed the process to become the registered manager.

At this inspection we found the home was consistently well-managed by the home manager who provided clear and direct leadership. Staff consistently told us the management team had created a supportive environment where their opinions and views were discussed and taken seriously, which made them feel their contributions were valued.

Quality assurance systems monitored the quality of service being delivered, which were effectively operated by the management team, to drive continual improvement in the service.

The home manager collaborated effectively with key organisations and agencies to support care provision, service development and joined-up care, for example; local GPs and community mental health and nursing teams.

People experienced care that made them feel safe and were protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations were carried out, in partnership with local safeguarding bodies.

Risks were assessed, monitored and managed effectively. Staff were aware of people’s individual risks and how to support them to remain safe.

There were sufficient staff to respond quickly and provide safe and effective care to people. The home manager operated a robust recruitment process, based on relevant pre-employment checks, which assessed the suitability of candidates to support older people and those living with dementia.

People's dignity and human rights were protected, whilst keeping them and others safe. Staff supported people who experienced behaviour which may challenge sensitively, in accordance with their positive behaviour support plans.

People received their prescribed medicines safely, from staff who had their competency to administer medicines assessed annually. People’s medicines management plans were reviewed regularly to ensure continued administration was still required to meet their needs.

High standards of cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection. Staff followed the required standards of food safety and hygiene, when preparing, serving and handling food.

Staff had an effective induction, ongoing training and support to maintain necessary skills and knowledge to support people effectively.

People were supported to eat and drink enough to protect them from the risk of malnutrition and dehydration. Risks to people with more complex nutritional needs were promptly referred to relevant dietetic specialists.

Each person had an individual health action plan which detailed the completion of important monthly health checks. People were promptly referred to external services when required, which maintained their health.

The provider had continued to improve lighting, signage and decoration of the premises to support the needs of people living with dementia.

The management team had ensured people’s ability to make decisions was assessed in line with the Mental Capacity Act 2005 (MCA). People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and Deprivation of Liberty Safeguards legislation and guidance.

Staff consistently treated people with compassion, kindness and respect. People were supported to follow their interests and hobbies which enriched their lives.

People’s choices and independence were promoted by staff supporting and encouraging them to do things themselves. Staff supported people to develop friendships within the home and maintain close links with their loved ones. This protected them from the risk of social isolation and loneliness.

People actively contributed to their care planning. Care plans were personalised and contained information such as the person’s life history, preferences and interests. People living with dementia had assessments relating to memory, mood, interactions and behavioural tendencies.

There were regular opportunities for people and staff to feedback any concerns at review meetings, staff meetings and supervision meetings. People and their relatives knew how to complain. The registered manager used concerns and complaints to drive improvement within the home.

People were supported with care and compassion at the end of their life to have a comfortable, dignified and pain-free death. Staff were thoughtful and consistently treated relatives with kindness, which made them feel involved, listened to, and informed, in the last days of their loved one’s life.

Applewood is a care home which provides residential care for up to 39 older people living with a range of medical conditions including diabetes and those living with Alzheimer’s and Dementia.

The care home comprises of two floors situated within its own secure grounds and garden in a residential area in a village on the outskirts of Basingstoke town centre. The home has 37 single rooms with two double rooms available, two communal lounges with televisions and colourful furniture and a quieter lounge adjacent to the reception area. Meals were served at people’s choice in their rooms, lounges or a dining room situated in a conservatory which looked out directly onto the gardens which homed chickens to provide interest and fresh eggs. At the time of the inspection 37 people were living at the home.

Applewood has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The registered manager was committed to and passionate about staff training and development. The registered manager used creative, proactive and innovative ways of developing staff that enabled them to apply their learning in their practice. Staff, family and healthcare professionals were encouraged to take part in Virtual Dementia Tours which provided them with the physical and sensory deprivation which can be experienced by those living with dementia. The learning from this training was used to inform staff’s interaction styles with people. This ensured that staff had the skills and understanding to deliver outstanding personalised, quality care.

The service provided care and support to people enabling them to live fulfilled, active and meaningful lives. The provider and staff were motivated to ensure that people were provided with the opportunity to participate in daily activities and homely tasks to retain their independence. The use of activities as a life enriching experience was understood by all the staff at Applewood. All staff, not just those involved in the delivery of care, participated to ensure people were fulfilled and had an active and interesting life which promoted their independence. Staff were highly motivated to develop close relationships with the people they were supporting. Staff used verbal reassurance and touch with people to ensure that people were involved and encouraged to participate in conversations and were able to engage with staff.

Relatives of people using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people. People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely. There were sufficient staff employed to ensure that people’s individual needs were met.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as a fire. Fire drills were documented, understood by staff and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Senior staff responsible for administering medicines had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Staff skills in medicines management were regularly reviewed by the registered and deputy managers to ensure staff remained competent to administer people’s medicines safely.

Care plans contained detailed information to assist staff to provide outstanding care in a manner that respected each person’s individual requirements and promoted treating people with dignity. People were encouraged and supported by staff to make choices about their care including how they spent their day either in the home or supported at external activities.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions in the best interests of people who lacked the capacity to make a specific decision for themselves. Staff sought people’s consent before delivering their care and support. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff showed a comprehensive understanding of what constituted a deprivation of a person’s liberty. Appropriate applications had been made to the relevant supervisory bodies to ensure people were not being unlawfully restricted.

People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and they enjoyed what was provided. Records showed people’s food and drink preferences were documented in their support plans and were understood by care staff who will be referred to as staff throughout this report. People were supported to eat and drink enough to maintain a balanced diet.

Relatives we spoke with knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with the registered manager. A support group for relatives had been created by a healthcare professional who visited the home every six weeks. This was to talk through any areas of concern they may have about their family member’s medical conditions and how it affected them and the care they received.

The registered manager and staff promoted a positive open culture which focused on providing individuals with the opportunities to continue to live the lives they wanted to. People were assisted by staff who encouraged people to express their views and feel comfortable to raise concerns with them and the registered manager. The provider routinely and regularly monitored the quality of the service being provided.

The provider’s values of care delivery were communicated to people and understood by staff. We saw these standards were evidenced in the way that care was delivered to people.

The registered manager provided strong positive leadership and fulfilled the legal requirements associated with their role. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. Where suggestions had been made to improve the quality of the service provided the registered manager took steps to immediately address these and ensured that appropriate actions were taken.

Relatives told us and we saw that the home had a confident registered manager and staff told us they felt supported by the registered manager.

All of the people we spoke with who lived in the home told us that they were happy. They all said they had 'no complaints'. Three of the people we spoke with told us how they would complain. They said they were confident that any issue would be quickly sorted out. Every person we spoke with said that the staff were very good.

People were encouraged to make decisions about their care and treatment. One person we spoke with told us how they could get up and go to bed when they liked. They said they 'didn't have to do anything they didn't want to.'

People had sufficient to eat and drink. The people we spoke with told us they enjoyed the food. One person said 'the chefs are excellent'.

There were appropriate arrangements in place for the ordering, storing, administering and disposal of medication.

Complaints were recorded and responded to in line with the home's policy.

Care plans were clear and detailed with up to date risk assessments. We looked at six care plans and saw that the support delivered was in line with the care and support required.

There were sufficient, appropriately qualified and skilled staff on duty and we were told by the people who live in the home that they were 'well looked after' and that 'nothing was too much trouble for the staff'. The staff were well supported with regular supervisions and appraisals. The training was up to date.

The provider had an effective system to monitor the quality of the service provided.