Apple Tree Care Home

Apple Tree Care Home is a residential care home providing personal care to up to 20 people. The service provides support to older people, some of these people are living with dementia. At the time of our inspection there were 19 people using the service. The care home accommodates people in one adapted building.

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

People felt safe and were protected from avoidable harm. Staff had safeguarding knowledge and the appropriate health and safety checks for the service were in place. People were supported with their medicines safely.

Staff were not always wearing personal protective equipment such as face masks correctly. We recommended the provider considers their approach to ensure infection outbreaks can be effectively managed.

There were enough staff to meet people’s needs. Staff felt they had time to spend with people individually. People told us they thought the staff were caring and had time for them.

People received personalised care. Care plans were detailed and reflected people being provided with choice and completing a range of activities.

The service was well led. People spoke highly of the manager and felt they were approachable. Both staff and the manager were aware of their responsibilities and demonstrated knowledge of their role.

The quality assurance systems were effective and had improved since the last inspection. The provider had an action plan in place to drive continuous improvements within the service.

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.

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 this service was good, published (October 2019). At our last inspection we recommended the provider review the quality assurance system in line with best practice. At this inspection we found the provider had made the required improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook this focused inspection in relation to the Key Questions; Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

¿ The registered manager had invited relatives to join a social media group where updates about the home were routinely shared.

¿ Staff testing residents for COVID-19 had received training to do so and tried to make this a pleasant experience for people. This enabled them to successfully test everyone living at the home.

¿ The provider had produced an information booklet for staff with clear guidance about COVID-19 and what was expected of them in their roles.

Further information is in the detailed findings below.

Apple Tree Care Home is a care home that was providing personal care to 18 older people and people living with dementia at the time of the inspection. The service accommodates up to 20 people.

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

People received a very caring and responsive service. Staff were highly motivated, sensitive to people’s emotional and physical needs and committed to providing good quality care. Staff were aware of risks to people’s safety and wellbeing and acted to minimise these risks. People received their medicines in line with their prescription.

People received care from staff who were appropriately recruited, trained and supervised. There was a focus on employing staff with strong person-centred values. 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.

Relatives were highly complementary about the compassionate end of life care provided by staff. They praised the support and sensitivity shown to themselves and their loved ones.

Care plans included information for staff about people’s needs and preferences and supported staff to provide person-centred care. People took part in a range of activities.

Systems were in place to check the quality and safety of the service. These systems had not identified some minor issues in relation to record keeping and accident monitoring. We have made a recommendation about quality assurance. Relatives told us the registered manager was very dedicated and caring. Feedback from people, relatives and staff indicated high levels of satisfaction with the service.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated Good overall (published 29 March 2017).

Why we inspected:

This was a scheduled inspection based on the service’s previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Apple Tree Care Home is a care home providing accommodation and personal care for up to twenty older people, some of whom are living with dementia. At the time of our inspection there were 19 people receiving a service. The home is located just outside the City of York in the village of Strensall. The service was previously registered under a different provider name, but had the same owners. Due to being a new provider and legal entity they were required to re-register the service with the Care Quality Commission. The service was re-registered in March 2016 and therefore this was the first comprehensive rated inspection since the new registration.

The service had 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 service is run.

People told us they felt safe. The registered provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse. Staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

Risk assessments were in place minimise the risk of harm to people. The registered manager agreed to rectify some issues we identified in relation to risk assessment documentation.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were sufficient staff available to keep people safe and meet their needs.

Staff completed a comprehensive induction programme to help them carry out their roles effectively, and there was a schedule for updating this training when it was required. Staff received on-going supervision and competency checks to support and develop them in their roles. Staff meetings were held regularly.

Medication was appropriately administered to people and recorded on their medication administration records. Staff responsible for the administration of medicines had received training and the registered manager completed medication audits and staff competency observations. This showed that there were systems in place to ensure people received their medicines safely.

Staff were able to demonstrate an understanding of the importance of gaining consent before providing care to someone and we found the service was meeting the requirements of law when people's liberty was deprived.

There was a warm and friendly atmosphere in the home, and a range of activities were available to people. The decoration in the home had been chosen with careful consideration for the needs of people with dementia. Colours and textures were used to provide stimulation to people and there was signage around the home to help orientate them.

People were supported to maintain good health and access healthcare services. We saw evidence in care files that people had accessed a range of healthcare support where required, and staff were attentive to any changes in people’s health. Staff at the service had developed positive working relationships and good communication with other healthcare professionals and services. People received support to ensure their nutritional needs were met.

We received unanimously positive feedback about the kind, caring and dedicated manner of staff. It was evident that staff knew people well and that people had very positive caring relationships with the staff that supported them. Relatives provided us with examples of how staff had supported people to gain confidence and develop friendships. We found that staff treated people with dignity and respect.

Visitors were welcomed at any time. Relatives were involved in the development and review of people’s care plans and felt their views were listened to. Staff had completed training with regard to end of life care and we saw positive feedback from families about the support staff had provided to their relatives at the end stage of their life.

There was a quality assurance system in place, which included a range of audits and surveys conducted by the registered manager. Some audits did not always clearly show the actions that had taken place as a result of the findings, but the registered manager told us they addressed issues as soon as they were identified. Survey findings and feedback we received during our inspection showed a high level of satisfaction with the care provided.

Feedback about the leadership of the service and the registered manager was consistently very positive and comments from staff indicated there was a positive, person-centred and supportive culture at the home.