Archived: Apple Tree Care

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.

People said they were well cared for, with comments including 'They are good staff, they'll listen to you, help you', 'It seems to be well run and organised" and 'Welcoming, pleasant and understanding and humane. It is a very caring place.' Arrangements were in place to assess and plan people's care needs, although the provider should note that some risk assessments had not been updated recently.

A choice of regular meals, snacks and drinks was provided, with arrangements in place to provide for any specialist dietary needs. People told us that the food was good, with comments including 'Terrific', 'Very good' and 'Oh the food is brilliant, I can't praise highly enough.'

Our observations showed that people's needs were met by a suitable number of staff. People we spoke to felt that staff were available when needed, with comments including 'The staff are just lovely' and 'There is always someone around.' However, some staff felt that increasing staffing levels would help them provide a better service.

People felt able to ask questions or raise concerns and felt that they were listened to. We found that comments or complaints had been responded to appropriately.

One person said, 'I am very lucky to be here.' The three visitors we spoke with told us they were involved and consulted in their relative's care.

People said they were well cared for. One visitor said, 'I am grateful for the way my relative is looked after, I couldn't have wished for a better place for them.' We observed the care staff being kind and respectful to people

The people we spoke with commented that they felt very safe and would go to the office if they had any concerns.

We saw the medications were locked in a secure cupboard. People were protected against the risks associated with medicines because medicines were kept safely.

The staff we spoke with told us that they had attended training to update their knowledge and skills. This helped them to provide the best care for people.

We saw that the home had systems in place to assess and monitor the quality of the service provided. This was so the provider could check the service was running well and in line with what people were wanting.