Appletrees Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question requires improvement. At this inspection the rating has remained the same. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Care plans were reviewed regularly; however, reviews did not identify some peoples care plans had conflicting information regarding them needing equipment to mobilise. For example, 1 person’s care plan said they required a wheelchair to access the community, another person’s care plan said they required additional equipment to mobilise. We clarified with the registered manager this was incorrect, and they made the necessary amendments during our site visits. However, the service used agency staff and incorrect information in care plans may be misleading. Permanent staff demonstrated good knowledge of people and their support needs and were able to explain to us how they supported people with specific care needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We received mixed feedback from people and relatives regarding their involvement in care planning. Some people and relatives told us they were part of the review process and others said they were not. One person told us, “I’m not involved in my care plan really, but I get the care I want”. Another person told us, “I do think I am involved with my care as they talk to me about it and what I like and want. They ask my permission before they do anything to me on a care level”. Where some people required care plans and risk assessments relating to their individual specific health conditions these were in place, but some required further detail to ensure staff had the required guidance to support people effectively. For example, where people had neurological conditions, information was not specific to their particular needs to guide staff to recognise any changes in their presentation.

The provider worked across teams and services to support people. People were supported by staff who worked in conjunction with other healthcare professionals. We received limited feedback from professionals; however, one professional told us they had difficulties contacting the service to make an appointment, but they were able to visit the service unannounced and were accommodated by staff. The staff team generally worked in delegated pairs for their shifts and we observed staff assisting each other where needed. The service had daily handover sheets to share information about people, although these were not consistently completed. For example, it was not always documented when people were taking antibiotics, what their current blood sugar levels were or when they had wounds. Although we found no harm to people, there was a risk clinical information was not always shared with the services nursing staff effectively. We shared this with the registered manager to start to take action to rectify this.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives. People and relatives told us they had access to external professionals when required, these included GP’s, chiropodists, physiotherapists, dentists and the mental health team. One relative told us, “They get their hair and feet looked after every couple of months here which we like. They have an optician in too, we purchased some glasses”. Another relative told us, “I have a telephone appointment with the GP next Monday as (relative) isn’t well, they have chiropody and get their hair cut here, they can have a dentist visit them too. We really are quite satisfied and feel they couldn’t have better care anywhere else”. The service had a dietician who visited monthly to review people’s weights, and (MUST) scores The Malnutrition Universal Screening Tool is a screening tool used to assess adults for malnutrition scores. We saw in care plans where people had requested referrals to the mental health team, these had been followed up and actioned.

The provider monitored people’s care and treatment. However, they did not always ensure outcomes were positive and consistent. Some people had their fluid and food intake monitored; we found gaps in daily recordings. One person we reviewed had lost weight, their fluid intake had not been reassessed, and their mattress settings had not been amended to accommodate the changes. This meant the person was not receiving the correct level of pressure care. This was amended during our onsite visits. The service was not recording people’s wounds and bruises consistently, where body maps had been completed by staff for bruising, these were only completed at the first instance and not monitored and reviewed regularly. The registered manager told us they had shared our findings with their staff team to ensure improvements were made and more consistent documentation would be completed.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. However, not all people living at Appletrees Care Home were able to consent to their care. We observed staff supporting most people where possible to make day to day decisions, such as what they would like to eat and drink and which activities they would like to join. One person told us, “Staff ask my permission before they do anything to me on a care level”. Staff shared a good understanding of how to assess people’s consent to care and treatment and why it is important to respect people’s choices. Where people required reviews of their capacity to make decisions about their care and treatment, there was evidence in people’s care plans referrals had been made to the local authority. The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty (DOLS). The provider monitored when people’s assessments and DoLS needed reviewing.