Apple Trees Care & Reablement Centre

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

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff reported that there were regular opportunities to learn from events within the service. Senior carers and heads of department participated in a daily ’11 at 11’ meeting, which the registered manager used to share learning and communicate actions arising from incidents. Staff described the incident reporting process as straightforward and accessible, with reports submitted via handheld devices. Feedback was provided through multiple channels, including the handheld devices, handover meetings, supervisions and staff meetings. This structured approach supported a culture of openness, continuous learning and accountability across the staff team.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe at the service and had confidence in the staff who supported them. Staff had completed safeguarding training and demonstrated a strong understanding of the types of abuse people might be exposed to, as well as their responsibilities in protecting those in their care. When we spoke with staff, they were knowledgeable and confident in their safeguarding role. We saw clear evidence when safeguarding concerns arose, they were thoroughly investigated by the registered manager and their team. They worked closely with the local safeguarding authority to ensure positive outcomes for the people involved.

Where people lacked capacity to make their own decisions, the provider used the principles of the Mental Capacity Act 2005 (MCA) to support them. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

A number of people were supported under Deprivation of Liberty Safeguards (DoLS). Their records showed best interest meetings had been undertaken to support individual decisions around their care in the least restrictive way. This included decisions for the use of bed rails to keep them safe.

The provider worked with people to understand and manage risks holistically. Staff delivered care that was safe, supportive, and enabled individuals to engage in activities that mattered to them. People's safety was well managed by the staff who supported them. There were detailed, person-centred risk assessments in place, tailored to each individual's needs. These included strategies for supporting people at risk of tissue damage or falls.

We observed the measures identified in people's care plans to mitigate these risks were implemented effectively. For example, pressure-relieving equipment was in use for those assessed as being at risk of skin damage, and sensor mats were used to alert staff when individuals at risk of falls were moving around the service.

In cases where people had lost weight, or needed support with their food and fluid intake, staff had systems in place to identify and respond to this. They worked to encourage people with their food and fluid intake. Care plans contained clear information about the level and type of support each person required with nutrition, and we saw staff providing support in line with these plans.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment in which people lived was safe, well-maintained and supported their wellbeing. A structured maintenance plan was in place, overseen by the provider’s maintenance team, who carried out regular health and safety audits in collaboration with the on-site team. The premises were secure while still allowing people safe access to communal and outdoor areas. Staff reported when maintenance issues were raised, the team responded promptly to address them. Clear servicing records were available, demonstrating equipment throughout the building was routinely checked and maintained to ensure safety and compliance.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We received mixed feedback from relatives regarding staffing levels. Some relatives felt there were sufficient staff to meet people's needs, while others expressed concerns there were times when the service appeared short-staffed. Staff we spoke with were generally satisfied with staffing levels and told us the management team worked proactively to cover short-notice absences.

Our review of staff rosters and the provider’s dependency tool, used to determine the service’s established staffing requirements, showed staffing levels generally met the assessed needs of the service. Where necessary, agency staff were used to maintain safe staffing levels. The deputy manager informed us that the service had recently changed agency providers to ensure greater consistency, with regular agency staff who were familiar with the people they supported.

Staff had access to a comprehensive training programme delivered by the provider. This included mandatory training in areas such as safeguarding, infection prevention and control, moving and handling and medicine administration. Training was delivered through a mix of online modules and face-to-face sessions, with refresher courses scheduled regularly.

Throughout our visits, we observed people were supported in a timely and responsive manner.

The provider had safe recruitment processes in place. All staff underwent appropriate pre-employment checks, including Disclosure and Barring Service (DBS) checks to ensure they did not have a criminal record. There was clear evidence staff had the right to work in the UK, supporting the provider’s commitment to employing fit and proper staff.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were protected against the risk of infection through clear policies and protocols that guided staff practice. Both people using the service and their relatives expressed satisfaction with the level of cleanliness, and the infection prevention measures in place.

One relative commented, “I do see carers wearing PPE,” and added, “The place is usually clean and pretty well maintained considering what they must deal with on a daily basis.” Staff we spoke with demonstrated a good understanding of how to reduce the risk of infection. This was supported by our observations of their practices throughout the visit.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People and their relatives told us medicines were well managed within the service. Each person had their own secure, lockable medicines cupboard located in their room, which promoted both safety and dignity. This arrangement supported personalised care and ensured medicines were stored appropriately in line with best practice guidance.

Our observations showed staff practices around the administration and storage of medicines were safe. All staff responsible for administering medicines received regular training and support in this area of care.

Where errors had been identified, robust investigations were carried out, and findings were shared with staff to help prevent recurrence. This demonstrated a proactive approach to learning and continuous improvement in medicine safety.