Appletree Grange

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. 

At our last inspection we rated this key question good. At this inspection the rating has changed to outstanding. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

This service scored 90 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity.New people to the service were given a ‘welcome basket’ on arrival which included a welcome card, information about the service and what to expect each day, toiletries and snacks to help them settle in. Staff communicated with people in an exceptionally caring and compassionate way. They gave people time to respond, listened to them and provided sensitive support to ensure people's needs were promoted. Staff knew people very well and recognised any changes in their well-being and advocated with relevant professionals where needed. For example, they had noted a person who had received an increased medicine was becoming increasingly distressed and upset, they monitored the person and worked with the professional to ensure their medicine was appropriate and that treatment aimed to reduce and not increase, distress. As a result of staff intervention, the person’s distress significantly reduced. They appeared calmer, more settled, and more comfortable in their environment. Staff reported increased positive interactions, and the person was able to enjoy daily routines with less anxiety. People, relatives’ and professionals’ comments included, “We understand each other most of the staff are Geordies like me”, “Staff are brilliant here, [Name] is better off here than in hospital”, “Staff helped me settle in. They are very pleasant people” and “I feel very much at home.” Staff always treated colleagues from other organisations with kindness and respect.Professionals commented, “Staff are really helpful, they are a breath of fresh air” and “We have a good relationship with all the staff.”

Staff treated people as individuals and ensured people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. As part of men’s mental health week, the registered manager introduced an initiative to raise awareness about men’s mental health and provide a safe space and support for male residents and staff. Goody bags were supplied for male residents and staff that contained a stress ball for relaxation, journal for reflective writing, healthy snacks and a book with tips and quotes about mental well-being. The residents were appreciative of the sharing, they said they felt valued and supported in being able to talk about the subject in 1-1 conversations and staff felt more confident in addressing mental health concerns.

Detailed person-centred information was collected about people's religion, likes, dislikes and any cultural preferences. Staff were aware of and had an in-depth understanding of people's needs, anxieties and aspirations. A relative commented, “[Name] makes choices, they wake up in their own time, staff respect that, as [Name] does not like to be woken up.” Staff established consistent and trusting relationships with people which enabled people to relax with the support provided. A relative told us, “[Name] is not the easiest person. Staff manage [Name] very well, they are so patient and make [Name] understand and help them relax. I don’t know how they do it, they are the same with other people too.”

People were supported to live their lives the way they wanted to. A person commented, “I like to be by myself and staff respect that. Another person who had had been struggling with confidence, felt they had lost their independence, was worried they would no longer be able to do the things and withdrew to their room. Staff worked with them to build a personalised care plan that included their preferences. They were encouraged to re-engage in gardening, 1-1 sessions where the person could read aloud from their book which the library delivered, they also took part in baking sessions, and this helped them rebuild confidence and social connection. The person now regularly joins in communal activities. We were told they have regained their sense of purpose and independence by continuing the hobbies they previously enjoyed. Their relative commented, “[Name] is back to being themself again, they are understood, and [Name] loves it here.” Staff had received training in equality and diversity to emphasise the importance of treating people as unique individuals with different and diverse needs. People received their care and support from a service which was entirely flexible and able to respond to individual requests and changes. A relative commented, “[Name] gets the support, they need staff do not rush them, they go at [Name]’s pace.”

Staff at the service were exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing. Independence and autonomy were promoted, whatever the level of need, and this was at the centre of the care and support that people received. People were supported to achieve a level of independence and to be fully involved in decision making and control in their lives. A relative commented, “Staff will encourage [Name] to join in, which they will if they want to.” Detailed care records documented how people's independence was to be promoted. People were supported to aspire and to achieve a level of independence and to be fully involved in decision making and control in their lives. Staff empowered people to be in control of these choices which led to a wider range of experiences for people and positive outcomes. A person commented, “It is nice to go back to having a bath, instead of a shower, I like the spa bath with the lights and the bubbles.” There were examples of where people had flourished and become more independent in terms of physical or emotional well-being. Examples included, a person who was not responsive to support with personal care was provided with a labelled laundry basket which enabled them to change their clothes themselves without embarrassment. Another person with visual impairment became more independent and enjoyed increased nutrition due to adaptations to lighting, where the person sat at mealtimes and the use of different coloured plates to help them identify what they were eating. Another person’s mobility and confidence in walking had increased as staff followed the physiotherapist advice, to walk with the person along the corridor twice daily.

The activities co-ordinator sourced a range of activities and entertainment for people to enjoy both inside the home and out in the community. People and relatives’ comments included, “Sometimes we go to the garden centre, or the Metro centre”, “I like helping with the plants”, “The therapy dog comes once a month”, “We play bingo and do crafts” ,“I listen to music and like to chat”, “I get photos of the baking they do” and “There is loads going on.”

Staff listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress. They worked calmly, compassionately and responded to people promptly. Staff worked very closely with people. They invested time in ensuring they were given the right level of support to promote their understanding. Relatives’ comments included, “If you use the buzzer staff come immediately. The carer comes in to check all was well, that happens regularly, especially as [Name] has just come out of hospital” and “In an emergency staff are there in a flash."

The provider cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care. Staff told us they felt valued and supported by the management team. They all commented they were encouraged to voice their opinions, ideas and suggestions. Staff comments included, “Staff welfare is important, management will be flexible with shifts and work patterns, staff retention is good”, “It is lovely here, everyone has been very accommodating, I learn and grow every day”, “I find work rewarding, there is a good team now” and “There are always people to ask for advice and support, the seniors, and management are all very approachable.”