Apple Trees Care & Reablement Centre

Apple Trees Care and Reablement Centre is a care home registered for 64 older people including people living with dementia. The home is split into four households with 16 bedrooms in each. At the time of our inspection one unit was being used as a designated setting for transitional care for people who had been discharged from hospital recovering from COVID- 19.

People’s experience of using this service and what we found

The staffing levels at night did not always meet the needs of people at the service. Since the introduction of the designated setting the way staff had been allocated had affected staff’s ability to provide timely care.

People’s medicines were overall managed safely, but we were told of minor medicines errors not being reported.

People had information in the care plans about how to manage the risks to their safety, however some risks to people’s safety were not always managed effectively

There were quality monitoring processes in place, however the analysis of incident such as falls of care did not always show theme and trends.

Staff were aware of how to protect people from the risks of abuse. There was infection prevention and control (IPC) practices in place so people were protected from the risks of infection. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives told us the staff team treated them with care and respect, and their views on their care were listened to. Staff showed a good awareness of supporting people’s privacy and encouraging their independence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for Apple Trees Reablement Centre was Good (published 8 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of staffing since the introduction of the designated unit at the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, caring and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well led section of this report

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apple Trees Reablement Centre on our website at www.cqc.org.uk.

We found the following examples of good practice.

¿ The service had developed a dedicated unit with en-suite rooms to care safely for people who were admitted to the service with Covid-19. The area had its own access and was able to be separated from the rest of the home. Measures were in place to keep people safe and well cared for, and to reduce the risk of infection spread to other areas. For example, staff only worked in this unit and did not access other areas of the service.

¿ Enhanced cleaning schedules including regular cleaning of touch areas such as handrails and door handles were in place. This reduced the risk of cross infection. Additional equipment had been purchased to enhance infection control measures. For example, portable handwashing stations, decontamination devices which neutralized rooms and soft furnishings and a machine that was able to determine how clean an area was by measuring bacteria.

¿ People were able to access the garden which had a specific ‘covid secure’ garden area which enable people who tested positive for covid to still enjoy the outdoors without placing anyone else at risk.

¿ Changes to staff practice throughout the pandemic period included staff not working across different floors and having access to different exit and entry routes. This reduced the risk of infection spread. Staff had received additional training in infection prevent and control and the use of PPE.

¿ Staff employed by the service did not work in any other care setting. This meant the risk of cross infection was reduced. A team of bank staff were used to cover vacant shifts as far as possible.

¿ The provider was proactive in keeping up to date with best practice guidance and had been involved in pilot schemes to assist with advancement in technology, infection control and covid testing.

¿ The infection prevention and control policy was up to date. People and staff had risk assessments in place to identify their individual risks associated with Covid-19. This meant protective measures could be put in place to keep people and staff safe.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Apple Trees Care and Reablement Centre is a care home registered for 64 older people and people living with dementia. The home is split into four households with 16 bedrooms in each h. There are two household’s downstairs and two upstairs. At the time of our inspection 59 people were using the service.

People’s experience of using this service:

People received excellent care from staff who were highly dedicated, extremely compassionate, kind and caring. They went above and beyond what was expected of them by volunteering to support people in their own time. Staff told us this was out of choice, they had high regard for the people in their care and had developed meaningful relationships and close bonds. People who used the service and visiting relatives were complimentary about the staff’s caring approach that they felt was exceptional. Staff were frequently described by people as being “a part of the family.” Staff treated people as equals and had developed trusting relationships and had in depth knowledge about people’s routines and what was important to them.

The registered manager had worked with the Alzheimer’s Society in developing and piloting training for staff, people who used the service and relatives called, ‘Lift the lid on sex, intimacy and relationships.’ This positive approach to care, recognised and celebrated the importance and equality and diversity and people’s rights to develop personal relationships with others.

Risks associated with people’s needs and choices were managed well and effectively, people were involved in discussions and decisions about safety as fully as possible. People lived in a safe environment that was monitored and equipment was serviced and checked on a regular basis.

Staffing levels were sufficient, but deployment of staff was found to have some shortfalls which was addressed immediately by the registered manager. People’s prescribed medicines were managed following national best practice guidance. The environment was found to be clean and hygienic and infection control practice had recently been improved upon. Incidents were monitored and analysed for themes and patterns and learning outcomes were used to reduce the risk of incidents from reoccurring.

The provider used recognised assessment tools to support staff to safely and effectively assess, monitor and manage people’s needs. Positive relationships had been developed with external healthcare professionals to support people with any health conditions to achieve good outcomes.

People had a choice of meals and drinks and any dietary needs, including preferences had been assessed and planned for. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received opportunities to participate in a varied activity programme including community and social activities. The environment was spacious, bright and of a high standard. End of life care was well planned to ensure people’s wishes were known and understood by staff. People experienced dignity and respect at the end stage of their life and relatives and loved ones were supported.

People had access to the provider’s complaint procedure, independent advocacy information and their communication and sensory needs assessed. People received opportunities to share their experience of the service and systems were in place to review the quality and safety of the service. The provider had oversight of the service and the registered manager had a commitment and drive to further develop the service.

Rating at last inspection:

The service was last inspected in March 2016 and was rated ‘Good’ in all key questions.

Why we inspected:

This was a scheduled planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received we may inspect sooner.

The home is new and purpose built incorporating design to support people with dementia to remain independent. It is registered to provide accommodation with personal care for 64 people. The home is split into four households with 16 bedrooms in each household. There are two households downstairs and two upstairs. One of the upstairs households provides reablement care to support people to return to their own homes and to be independent. The door to this household is mainly closed to support these people to have quiet time and space to complete their rehabilitation. The other three households are for people living with a dementia, their doors are open and people are supported to move between these three households whenever they choose. There were 63 people living at the home on the day of our inspection.

The home 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 home is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. The registered manager had made appropriate requests for people to assessed under the DoLS and all the care provided minimised the restriction on people. However, at times care plans were not always clear on how individual assessments of people’s decision making ability had been completed and how decisions had been made in people’s best interest.

The registered manager monitored staffing levels to ensure there were enough staff to meet people’s needs and completed appropriate check to ensure staff were safe to work with the people living at the home. Staff were polite, respectful and caring worked to the provider’s values to promote independence and support people to live a fulfilled life. In addition the staff worked together as a team to provide a high quality service to people living at the home.

People’s needs were assessed and people were involved in developing their care plan so that it met their individual needs. In addition staff monitored people’s abilities and changed care plans to reflect changes in needs. Staff were kind and compassionate when providing care and ensured that people were fully involved in their care and supported to be as independent as possible. the provider and registered manager had used the options in the design of the care home to offer people’s the ability to store their medicines in their own room. This facilitated medicines being offered to people in line with how people would manage their own medicines at home. Risks to people were identified and care was planned to reduce risks and to keep people safe from harm.

People were supported to access a choice of food and were able to access hot and cold drinks on demand. In addition the provider had incorporated good practice around supporting people with dementia to access and enjoy their food. People’s ability to maintain a healthy weight and to eat safely was assessed and support from healthcare professionals had been accessed when needed.

The provider had worked collaboratively and built good relationships with the healthcare professionals needed to support people in the reablement unit and throughout the home.

The provider had effective systems in place to monitor the quality of the care provided and to ensure that staff stayed up to date with any changes in legislation and guidance on how care should be provided. In addition the provider listened to the views of people living at the home, their relatives and staff to make changes to how care was provided.