Apple Tree

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.

This is the first assessment for this newly registered service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There was a process in place to ensure people’s needs were assessed. The assessments we reviewed considered people’s individual risks, needs and preferences. Relatives and those important to people were involved with the process.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider ensured and implemented the right support, right care, and right culture guidance. Staff were well trained and confirmed they received excellent support and training to meet the needs of the people they supported effectively. Staff were aware of national guidance and recommended approaches; they were focused on delivering individualised person-centered care for people. One staff member told us, “The training is very good, it’s specific to the people and their diagnosis which make it better for us and for them.”

There was an ongoing schedule of training which was regularly reviewed and updated dependent on the changing needs of people. This included Oliver McGowan training (this is the government’s preferred and recommended training for Learning Disability and Autism). Positive behavior support and physical intervention training was also completed, which had been specifically adapted to meet the needs of the people supported. This meant people could receive care tailored to their individual needs and delivered consistently to them by trained staff.

Staff encouraged and promoted people to live independent fulfilled lives. They empowered people to be in control of their lives and let them lead on their daily routines. There was emphasis from the provider about developing a good quality of life for people and this was promoted by participation in activities and tasks within the home and the wider community.

There was also a system in place which used evidence-based tools to assess people’s needs. A variety of assessment tools were available if needed to ensure people’s needs were identified and met. Staff were aware of these outcomes to ensure they delivered the correct care that people needed.

The provider worked well across teams and services to support people.

Staff had been specifically recruited for the people they supported and because of this had consistently worked together for a long period of time. Relatives felt staff worked together and alongside the service to achieve positive outcomes for people. A relative told us, “The staff are all a good team, if 1 is off sick, they cover for each other and I know them all.” Another told us, “There are always other professionals involved which I think is important”.

We saw staff worked together collectively to deliver effective care to people. There were regular reviews and team meetings as well as daily handovers, where individuals need were discussed. Where needed, specialist advice was sought from professionals to ensure the care and treatment people received was tailored to their individual needs. Referrals and input were sought from a whole range of professionals including, learning disability nurses, psychiatrists, speech and language therapists, nurse specialists and GP’s.

All staff knew people well and shared with us what made them an effective team. One staff member said, “The staff team are like a family, we included the managers in that.” Another staff member said, “We are listened to by the mangers and that’s important, it makes us all happier and better working together.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control.

People’s health needs were monitored and reviewed. A relative told us, “They react quick if something changes and get them to see someone.”

People’s health needs were identified, assessed and reviewed. When people needed support from external health professionals, there was a system to ensure referrals were made and care plans were updated to reflect any changes or recommendations. People had regular health appointments and reviews and where possible, people attended in person.

People had individual plans in place which identified the best way for people to attend the appointments. For example, for 1 person they attended the appointment as near to the time as possible. This reduced the amount of time they were waiting and therefore the anxiety they may face.

Hospital passports were available should people be required to attend hospital. These detailed people’s needs including their communication, mobility and health needs, along with their risks and presentation during periods of emotional distress. Staff told us they were aware of these plans and would take them to hospital with people if needed. The provider used a variety of health monitoring tools to assess and manage known risk.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Without doubt the outcomes achieved for people were exceptional. There was evidence to show 1 person was more engaging with staff since moving into the home. There was an initial period of instability which had resulted in periods of emotional distress for the person. However, slowly staff worked alongside the person to develop a calm and trusting relationship and this had resulted in a more sustained period of stability for the person. The consistent routine that had also been introduced showed this person was expressing less periods of frustration and anxiety and records we viewed supported this

For another person, initially certain activities had resulted in an escalation of triggers of behaviours and periods of emotional distress. The staff team worked alongside this person at their pace to develop trust during these times and this had resulted in the person completing more activities outside of the home.

People’s journeys were tracked and staff worked collaboratively with them and those important to them to celebrate their journeys. They mapped milestones and activities for people. This included in house sensory experiences, pub meals, car journeys, visits to the local park, swimming, theme parks, stays with family and holidays.

The staff worked with people to embed achieved outcomes into their daily routines to ensure people continued to use the skills they had learnt. For example, 1 person had independently learnt to brush their teeth, this was now embedded and care planned as part of their daily routine.

Goals and aspirations for the future were also identified as part of this process. Goals for people included, introducing a wider range of communication cards and trialling new beaches for a different experience.

Regular review of care, audits, reflective practices and goal setting ensured people’s outcomes were consistently monitored. The management and staff team were always striving to improve the service and make things better for people. There was an emphasis from staff on how people could be supported to maintain and develop new skills.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Capacity assessments and best interest decisions were in place when needed to ensure the Mental Capacity Act was applied. Staff were able to demonstrate an understanding in this area including the importance of gaining consent from people. They had also received training in this area and were aware of the processes to follow.