Appletree Grange

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. 

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff at the service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Relatives’ comments included, “We came in and gave information for the care plan. We had a meeting in the first few weeks, we were all listened to” and “I was asked if [Name] needed 1 or 2 staff for support, staff took lots of details.” Staff said there were effective systems in place to assess and monitor people’s needs. This included handover meetings between incoming and outgoing staff on shift and staff meetings. Staff members’ comments included, “If there is a new person or if there have been any changes since last shift there is a ‘red bell symbol’ on the system that indicates there is new information and staff are alerted”, “We will get an alert if staff are late with any planned observations/interventions.”

Staff 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. Staff ensured people’s health needs were monitored and they received a nutritious diet, which, when needed, followed dietitian’s guidance. The catering staff understood people’s needs and how to promote a healthy diet. Staff closely monitored people’s health and made sure they ate and drank well and were not showing signs of ill-health. People and relatives’ comments included, “Staff encourage [Name] to eat more, they were not drinking enough, there are drinks to hand” and “There is plenty to eat and drink.”

Not all areas of the home promoted people’s independence and orientation. We discussed this with the registered manager, to ensure the environment is appropriately designed to meet the needs of people who may live with dementia, or a dementia related condition, to keep them orientated and maintain their independence. A relative commented, “The building is tired, it needs a general make over. That is not detracting from the staff care.”

Staff at the service worked well across teams and services to support people to ensure they received timely, seamless and consistent care. They made timely referrals and worked very well with other agencies to ensure people's treatment needs were met. A professional commented, “Staff always keeps me up to date with the ongoings of my client.” A staff member told us, “We have great relationships with the GP and Nurse practitioner, they are absolutely fantastic.”

Staff always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Good oral health care was promoted, and staff had attended sessions from the local ‘mouth care for adults’ programme and a champion had been appointed to provide training to new staff to raise the importance of oral care for people. Staff worked closely with other professionals and the local GP practice who ran weekly ward rounds in the service. People and relatives told us they were supported to access health care. Their comments included, “Any problem or any concern about [Name], staff get the doctor, who comes once a week” and “Staff contact the doctor, they did this at the weekend when [Name] was poorly” and [Name] gets the support, the occupational therapist was in, staff try to get things done.”

Staff at the service 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. Care plans were detailed, personalised and provided guidance to ensure outcomes could be met, ensuring people received safe, consistent and effective support. There was a system of regular evaluation of risk assessments and people's care plans. Reviews were carried out regularly with people to ensure people's support and outcomes were monitored and in line with their wishes. A relative commented, “We have talked about the care plan, and we have meetings to discuss it.”

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment. Assessments were carried out, around people’s mental capacity and care records contained relevant information. Records captured all the relevant others involved in Best Interest decision making, where people did not have the mental capacity to give consent.