Archived: Apple Tree House

There is a registered manager in post. 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 had communication difficulties associated with their autism. We met three people who lived at the home. We were unable to speak with people using the service due to their highly complex needs. We therefore spoke with people’s relatives, staff and healthcare professionals to help form our judgements.

Relatives told us people were kept safe and free from harm. There were processes in place to help make sure people were protected from the risk of abuse and staff were aware of safeguarding vulnerable adult’s procedures.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

The manager undertook spot checks to review the quality of the service provided and made any necessary improvements to the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People living in the home were treated with dignity and respect by the staff that supported them. We received a number of positive comments, a care worker said "this is their home, they decide what they require from us" and a person living in the home told us "it's nice here". One relative told us 'the staff are very good, I can't praise them enough'.

Staff we spoke with were able to tell us what action they would take if they saw abuse taking place and where to find the correct contact information and procedures. One staff told us 'we have a job to do and it's our duty to report any type of abuse."

Staff carried out a range of health and safety checks to ensure people were kept safe. Records showed that fire drills were carried out and people had their personal emergency evacuation plans.

Where there were risks associated with people's health, these were assessed and appropriate support plans put in place. For example, we saw that a person in the home who needed help moving had very detailed instructions for staff on how it was done. There were also photographs with the instructions to help ensure the person was moved safely by the staff.

Is the service effective?

People living in the home and their representatives were involved in the care planning and review process. Annual care reviews involved the person living in the home and they contributed towards their agenda. This helped ensure that support was person centred and reflected the needs of each individual. One relative had just attended a meeting with staff and a social worker to discuss an aspect of a person's health, told us 'the staff phone me or email me regularly and I attend the annual reviews'.

Staff told us that communication was good in the home, so that staff would be aware of any particular issues relating to individuals. One way information was discussed was at handovers.

Staff confirmed they had regular supervision and the records showed that the supervisor held meaningful discussions to ensure staff understood their role and responsibilities. A member of staff told us 'I love my supervision; it's great to put my point across'.

Is the service caring?

People that we observed during our inspection reacted positively towards staff. We saw a lot of non -verbal communication between people and staff, playing little games between themselves which brought smiles to people's faces. One person told us 'it's nice here' whilst a relative said 'I've never had any concerns'.

We noted that staff were providing personal care in bedrooms with the door closed. This practice of respecting a person's privacy was confirmed by a person living in the home and their relative who said 'the bedroom doors are always kept closed'.

We made observations of people receiving the support they needed, in line with their care plan. For example, we saw that one person was sat out as instructed in the care plan whilst staff spoke to another person with phrases which helped the person remain calm.

Is the service responsive?

We saw that the service worked well with other healthcare professionals. For example, one person had recently had a visit from a speech and language therapist. We saw from the care records that a GP and a dentist were contacted because staff had concerns about a person's health.

The way people expressed their likes and dislikes had been recorded so that staff could understand people's wishes. Relatives told us that staff contacted them on a regular basis to discuss any changes to care and support. One relative told us "I get monthly news letters and weekly emails which means I know what is happening".

People could make choices. We regularly heard staff asking people to make a choice. One staff asked a person "are you going for your coffee? Shall we go into the lounge together'?

We saw that accidents and incidents were recorded, analysed and action taken to reduce the chances of it happening again. This provided opportunity to identify any learning points and put any required action plans in to place.

Is the service well led?

We saw there were systems in place to monitor the quality and safety of the service. This included gathering the views of people living in the home and their relatives. People had opportunity to attend monthly home meetings and the minutes showed that all the people at the meetings were asked for their view and their responses recorded.

The home received regular visits from the representatives of the registered provider. One of the external manager's reports which we viewed provided an overview of their visit, an evaluation and recommendations.

Any accidents and incidents that occurred in the home were recorded and analysed on a monthly basis. We saw evidence of where action was taken to reduce the risk.

The registered manager explained how the service worked hard on selecting staff which were suitable for meeting the needs of people using the service. The recruitment records showed the detailed interview questions used to select the right staff.

The records which we asked for were made readily available for us and the registered manager could provide the evidence which we requested to see. This showed that the registered manager was fulfilling her role and responsibilities to manage the service effectively.

We spoke with four staff during our visit. Staff were very motivated, caring and positive about working in the home and the teamwork and supportive atmosphere. Staff told us it was a good place to work.

People were encouraged to make day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

We looked at staff records and found the staff had consistent supervision and were well trained. We also saw there were systems in place to make sure people who used their service and their representatives could raise concerns and these would be dealt with promptly.

We looked at people's care, support, activity and health records. Records were consistently detailed, well-maintained and kept up to date in order to reflect their needs and provided clear guidance for staff to follow

We saw that the home used pictures and symbols to enable people to express themselves. There was constant interaction between staff and people who lived at the home which enabled people to make choices about all aspects of their day to day lives. People were able to make choices about how they spent their day and what they ate. We saw one person had tokens which they showed to demonstrate that they would like a snack.

Each person had an activity plan which had been drawn up with them taking account of their interests and hobbies. We saw that activities were personal to the individual and included, college courses, swimming, horse riding, going to the gym and trips out. During our visit people took part in a variety of activities. One person chose not to go out and stated that they wanted to stay in the lounge and watch a video which they did.

Throughout our visit we observed that there was a relaxed atmosphere in the home and people appeared very comfortable with the staff who supported them. People had unrestricted access to their personal rooms and the main living areas.

The home had a variety of ways to seek the views of people who lived at the home. These included questionnaires and service user meetings.