Applecroft Care Home

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

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s health, social and emotional needs were assessed before they moved to the service. This included information about how people communicated their needs, their specific medical conditions and how they liked to spend their time. These assessments were used to develop the person’s care plans, associated risk assessments and make the decisions about the staff skills needed to support them.

People and relatives told us they were involved in their assessment and care planning process. A relative said, “Initially I shared information about my family member with the home as they assessed her. The manager of the unit asked me to come and have a chat and I was shown the care plan. I think I was listened to and they valued my involvement.” Another relative said, “The assessment was partly done in hospital. We were listened to as a family and things related to their care were adjusted accordingly.”

Staff were knowledgeable about people’s care and support needs. They were able to describe people’s preferred routines, the best ways to communicate with people and how to support people with their physical and emotional well-being.Assessments included making sure that support was planned for people’s diversity needs, such as their religion, gender and culture.

The provider 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.

People’s needs around their eating and drinking had been assessed. Referrals were made to the speech and language therapist (SALT) when needed. For example, it was noted that a person kept food in their mouth when eating, which increased their risk of choking. There were clear directions to care and kitchen staff about the texture of people’s food and drink that had been recommended by the speech and language therapist (SALT). Care staff were knowledgeable about how to prepare drinks for people that needed to be thickened according to SALT guidance. There was a detailed sheet in the kitchen advising the chef and kitchen staff about people’s dietary needs and allergies. The chef explained how people’s food was served on different coloured plates which corresponded with the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. IDDSI isa global framework providing a common language for texture-modified foods and thickened liquids for people with swallowing difficulties.

The service had followed guidance from Kent County Council and Kent Community Health NHS Foundation Trust to support residents to maintain a normal diet. Supportive measures were put in place to monitor people, so they were not at risk when eating a normal diet. This included supervising people’s meals and gentle reminders to take small bites and to chew thoroughly. This had resulted in people enjoying their meal times and gaining weight.

Lunchtimes were busy as a lot of people needed encouragement to eat their meals and got distracted and left their meals to walk around their home. Staff endeavoured to give people the support needed, staggered people’s mealtimes and enabled people to sit where they wanted to eat their meals. People who were able to eat independently were supported to do so with the use of aids and adaptations where needed.

People and relatives gave some mixed views about the choice and quality of food provided. Relatives said people had meal options and kitchen staff provided alternatives if people did not like the meals available. A person told us, “The food is really nice and I’m getting enough.” People told us snacks and cold and hot drinks were constantly available throughout the day.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The provider had a clear process in place to escalate health concerns.

The service worked with a wide range of health and care professionals including doctors, speech and language therapists and diabetic nurses. The new manager, who came into post during our assessment, told us they had contacted the local doctor’s surgery to introduce themselves. Where guidance had been provided by professionals, it had been recorded in people’s care notes so it could be followed by staff. There was a clear process to escalate health concerns in a timely manner.

Feedback from health care professionals was positive. One health care professional told us, “Applecroft care team are all aware of the clients they care for and can provide accurate information regarding them. This includes records such as care plans risks assessment and bowel charts.”

The provider supported people to manage their health and wellbeing. Staff supported people to live healthier lives.

Information about people’s health was clearly recorded so it was accessible to staff. People’s care plans highlighted to staff if people had any specific health care needs that needed monitoring. This included if people had pressure areas that needed regular treatment or they needed to drink a specific amount of fluids. Nurses undertook regular observations of people’s well-being, monitored people’s health and liaised with health care professionals. Daily clinical meetings were held to discuss people’s health conditions and review any actions that needed to be taken.

Relatives were positive about the support staff provided to manage people’s health. They told us they were informed of their family members health care appointments. They said these included the hospice, neurology, chiropodist and dementia and mental health teams. Staff knew people well could identify when there were changes in people’s health and refer them to health care professionals for advice and treatment.

The activity programme included different forms of exercise and there were long corridors whereby people who wished to exercise could walk around their home. The chef told us they walked around the service on a Friday, offering people appetising trays of cut fruit to encourage healthy eating.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Care plans detailed people’s care and support needs, as well as their clinical needs in relation to health conditions.There was clear documentation with regards to people’s pressure areas. These included photographs of the wound, together with a treatment plan and assessment of the effectiveness of the treatment with weekly evaluations. Daily notes recorded care and health interventions to give a record of people’s health and well-being throughout the day. Changes in people’s care was recorded and used in handover notes to inform the staff team.

Meetings with the deputy manager and nurses were effective in monitoring and improving people’s outcomes. These meetings included an overview of wound management, health appointments, any infections, safeguarding’s and people’s medicines. The deputy manager audited people’s health records to identify if there were any people who needed closer monitoring to maintain their health. This information was then shared with nurses to they could take appropriate action. For example, if it had been identified that a person’s fluid intake was lower than expected or their bowels had not been open for several days. These monitoring actions helped to prevent people from becoming dehydrated or constipated. There were also regular meetings with nurses and care home assistant practitioners to discuss clinical practice. At the last meeting in before our assessment, it was noted there had been improvements in clinical standards.

Staff understood the importance of gaining people’s consent and respected this when delivering person-centred care and treatment.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, 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 staff had been trained in the principles of MCA. We observed staff gained people’s consent before offering any support or assistance such as helping them to mobilise or eat. A relative told us, “Yes, they are very good like that, asking for her consent.” Staff understood that people were assumed to have capacity but sometimes this fluctuated due to periods of confusion. Another relative said, “The carers come in and say hello. They tell him, we want to wash you or change you. If he says no then they leave him and come back later.”

The service managed DoLS by making and monitoring applications and keeping a record of these and any associated conditions. Mental capacity assessments included specific decisions about whether people could understand, retain and weigh up the information and communicate their decision. A health care professional told us, “They ensure liberty for clients is considered and apply for DoLS as needed.”