Apple Tree

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

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

This meant people were safe and protected from avoidable harm.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were learnt to continually identify and embed good practice.

Information was continually used to ensure lessons were learnt and changes were made to the service. There was a positive learning culture in the home which used incidents that had occurred to review and grow the service to ensure improvements for people were continually made. We spoke with the leadership team who told us how an incident had occurred, they told us how a piece of equipment had been damaged, and how this had been adjusted and changed for the future to ensure this could not be damaged again. The new equipment had a positive impact on the person this related to.

The provider used a lessons learnt document. It included detail on what the situation was, what happened during this time and how a reflective discussion took place within the team to review this. There was also a lessons learnt analysis and a future actions and outcome section which related to people. There were systems in place to ensure lessons were learnt to ensure good practice was continued, staff felt involved with this.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

People’s transition into the service was exceptional. Relatives, staff and professionals spoke positively about this. One relative commented, “It was positive.”

As part of this process, staff worked with people daily in their previous environments for the necessary time frames needed. This could be weeks or months. They did this while they developed a bespoke individual service and environment to meet their needs. There was a detailed robust transition plan in place which adopted a multi-disciplinary approach and involved a variety of supporting professionals. The transition plan looked at the holistic needs of the people and considered how risks, their wellbeing, and their health and psychological needs could be managed during this time. Transition plans were continually reviewed, adapted and developed, with families and professionals, to ensure a safe transition for the person into their new home. The plan was set at the persons pace meaning the plan and the person could adapt at the different stages and was guided by the persons individual needs.

People had care plans and risk assessments which they had developed, which were based on these assessed needs that were continually reviewed and updated when needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

Relatives raised no concerns around safety. One relative told us, “Yes they are safe, I have no concerns.”

The safeguarding procedures in place ensured when needed concerns were identified and reported. Staff told us they had received training and were aware what action they should take if there were concerns.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In [care homes/hospitals], this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found that when needed, DoLS were in place for people. The leadership team were proactive in ensuring DoLS were reviewed when needed for people and when restrictions were placed upon people they were continually reviewed and updated to ensure support was provided in the least restrictive way. One person, for many years had used equipment to keep them safe when in a community setting. The staff team had worked alongside the DoLS team to look at trialling other options when out in the community. Although this was in the early stages of transition, staff felt positively about this. One staff member told us, “Even if it’s only occasionally not to have that restriction all the time could be so beneficial, it would just be a little bit of freedom.”

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

No concerns were raised with the management of risk. People appeared safe and comfortable in their environments. A relative told us, “I think the staff are aware of any risks, they handle [person] well they are proactive at making changes.”

There was a system in place to ensure people had care plans and risk assessments that were reflective of their current needs. Care plans and risk assessments were developed individually with people and those important to them. They considered how people could be involved with this process and adapted this to ensure they were involved.

These plans considered people’s mobility needs, oral health needs and any known risks such as during times when they maybe emotionally distressed. These were reviewed regularly or when changes had occurred.

The provider detected and controlled potential risks in the care environment.

People looked comfortable in their environment and raised no concerns to us. Relatives spoke positively about the environment. One relative told us, “Its lovely.”

The environment had been adapted and decorated to meet people’s individual needs. Where needed, any risks to the environment or premises had been considered and assessed, such as fire safety. There were processes in place to ensure any risks were identified so that appropriate action could be taken.

The provider had systems in place to ensure there were enough staff available to support people.

There was enough staff available for people and staffing was delivered in line with people’s assessed levels of need. People used the hours they had been allocated to complete tasks in their home and in the community.

A relative confirmed there were enough staff available. One relative said, “There is always the amount there should be.” Staff felt there were enough staff available and ensured if someone was absent from work, they would all work together to ensure support was provided in the correct way. One staff member told us, “We are a team, so we work together if someone goes off, we don’t use agency.” There was a system in place to work out the number of staff that were needed to ensure people were safely supported.

Staff had received training, including training that was specific to people’s individual needs.

Staff had received the relevant pre-employment checks before they could start working with people to ensure they were safe to do so.

The provider assessed and managed the risk of infection.

We saw the home was clean and people were protected from the risk of cross infection. Staff told us and records confirmed they had received training. There was enough Personal Protective Equipment (PPE) available for staff and when needed this was used correctly. There were processes in place to monitor IPC to ensure concerns were identified so that appropriate action could be taken.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

No concerns were raised with the management of medicines. One relative told us, “The staff do the tablets I am not aware of any issues”

We saw medicines were stored safely. When people had ‘as required’ medicines there was guidance in place for staff to follow. Staff administering medicines had received training and their competency was checked to ensure they were safe to administer these to people.