• Care home policies on oral health and providing people with support to access dental services
• Oral health assessment and mouth care plans
• Daily mouth care
• Care staff knowledge and skills

CQC, during their discussions at the Regulation of Dental Services Programme Board and with other stakeholders across adult social care and primary care, highlighted that awareness and take-up of the NICE guidelines were still low.

CQCs review included dental inspectors attending 100 routine planned inspections of care homes alongside inspectors from their adult social care team. They spoke with managers and senior staff members as well as people who use services, and their relatives, to find out about their experiences of care.
Smiling Matters is a report of what was found in those homes, conclusions and recommendations for action.

In Apple House care homes, we have used the report to raise awareness of the importance of clear guidance within our own homes to ensure that access to regular dental check ups, care plan guidance and daily mouth care is and continues to be an important part of a person’s person-centred support. We have found that staff training is crucial and this goes hand in hand with the understanding of creative support plans which reduce barriers to people receiving oral healthcare. An area of action will be to include how people find this experience within our annual service user survey to gain the views of the people we support. An area of excellence was found to be specialised training received by members of staff which has been rolled out to the teams. The report has been discussed and communicated throughout the organisation at senior, team and service user meetings.
One of the recommendations from the CQC report is:
That NHS England and local commissioners:

• Work with the care home sector to avoid lengthy waiting times for appointments and treatment and provide emergency appointment times. 

• Work with GP practices and other primary care contractors, such as community pharmacists, to establish local arrangements to signpost people to dental provision. 

• Provide adequate capacity to provide routine and emergency treatment to people in care homes. This should be linked to a clear, measurable outcome around avoidance of GP appointments and A&E attendances resulting from dental crises.

You can read the full CQC report ‘Smiling Matters: Oral health care in care homes’ here.

Romaine Lawson, Director of Operations, Apple House care home group.

We are delighted to announce our recent CQC inspection report for Corner Cottage has been rated “Good” in all 5 key areas. This is a testament to the hard work and dedication our team there has put into keeping people safe and well looked after during the Covid-19 pandemic.
Our team at Corner Cottage, led by Sally and Bob, have gone over and above to ensure they are leading by example and supporting the whole home to thrive.
The CQC visit took place on the 28th April 2021. Some of the comments represented in the report are..
Throughout the inspection we observed positive interactions between staff and people. Staff showed genuine warmth and compassion when supporting people. Staff knew people well; they knew what was important to them, their likes and dislikes and respected their wishes. This enabled staff to support people in ways they preferred. The service took a person-centred approach to care and support. Staff were respectful about the people they supported and had completed training on equality and diversity. People’s care plans and support records set out aspects of their characteristics, beliefs and preferences to ensure their equality and diversity were respected.
People were supported and encouraged to express their views about how they received their care. A member of staff told us, “It is so lovely here, everything is for the residents, it’s all about them, it’s fantastic. [Person] chooses who they want to support them with their care and their wishes are always respected.” People, family members, staff and health care professionals were all involved in decisions regarding ongoing care and support. Staff supported people to make choices affecting their daily care and support. Support plans considered people’s disabilities, age, gender, relationships, religion and cultural needs. There were weekly house meetings where people were given the opportunity to share information that was important to them and put forward their views, preferences and ideas. Staff offered people encouragement and support to make decisions they may find difficult. Staff respected people’s choices and their rights to do what they wished.

Registered manager, Sally, said of the report, ‘My team have all worked very hard over the last twelve months, during this very difficult time in the world, and this wonderful outcome reflects the amount of effort and dedication we have all put in.’

Thank you so much to the wider team, families and individuals all involved with Corner Cottage to make it such a wonderful place to live.
You can see the full CQC report here:
https://api.cqc.org.uk/public/v1/reports/55983b59-4d07-4b95-b3a7-60ab673fa8d4?20210609120000
Romaine LawsonDirector of Operations

Please read our letter to families by clicking the download link below.

Joined by CQC and leading representatives of the sector, presentations and discussion will centre on what is already being achieved and what work can be done to take John’s Campaign’s ethos even further forward.

John’s Campaign was founded in 2014. Since then, overwhelming support has been shown from across the UK. Over 1000 wards, hospitals and other institutions have pledged their support. 58 MPs from across political parties signed an Early Day Motion in December 2014. Following this, the then PM, David Cameron, voiced support on the Andrew Marr show. A year later, NHS England officially endorsed the campaign, including it in their 2016/17 Commissioning for Quality and Innovation payment framework.

Apple House proudly adopted the core principles of John’s Campaign in 2017 and were commended for this by CQC as part of their inspection which led to a rating of our Hampshire care home, Summerwood, as ‘Outstanding,’ achieved by only 1% of care and nursing homes in the UK.

On Thursday we will be discussing how we greatly value the excellent inclusive relationships we work hard to establish and maintain with family and friends of people we support.  

Our team extends beyond ourselves in reaching out to the people outside our organization for their ideas, input and involvement.  We do this by whatever means are appropriate to the individual and can include social media, Skype, our Open-Door policy and regular face-to-face meetings.

— Jane Montrose, Managing Director, Apple House Care Homes.

We recognise as a company that working with the people who can specialise in the best proved systems in our field will afford us the time to do what we do best and provide outstanding care and support. 

Quality Compliance Systems are a market leader in the Care Sector for providing expert written Policies and Procedures, with over 50,000 users accessing the System daily.

QCS has provided Apple House documents completely personalised to our company.

The System is an online platform in which each staff member will be provided their own login details and will be able to access all available policies and procedures. Each person will also have their own reading list which will assist in their individual training pathway.

As part of the partnership, Quality Compliance Systems offers a Customer Care Support Team to help our teams every step of the way. Our staff teams will be able to contact them at any point for any support needed.

Apple House and QCS are committed to supporting all employees, and we welcome people to come to either of us with any questions or feedback.

The Managers of each Home have been undergoing individual training sessions for the new system and are now available to answer any questions.

One of the joys of implementing this system is the instant updates and an easy-to-use online interface; the system provides fast access to up-to-date policies and procedures. We look forward taking this forward and will keep you updated with the implementation across the company.

— Romaine Lawson, Director of Operations, Apple House Ltd

Staff had an excellent understanding of people’s needs and worked with them to ensure they were consulted, listened to and valued. –CQC

CQC is the independent regulator of health and adult social care in England.  The inspection was unannounced and took place over two days on the 27^thFebruary and the 1^stMarch 2018.

Our teams have demonstrated their unfailing commitment to providing a high standard of care and support at Apple House.

We would like to share below some of the report’s findings and you can also view the full report HERE

Safe

We spoke with three people who lived at the home, all of whom were living full active lives. They all told us they were happy living at Apple House and were keen to be part of the inspection. No one had any concerns about safety and they made comments such as: “I am very happy here”, and, “This is a nice place to live”.

The registered manager had also taken steps to make sure people’s care was delivered as safely as possible as all aspects of people’s care had been risk assessed. The risk assessments showed that the service was not ‘risk adverse’, as people were supported to take calculated risks in meeting their objectives.

One person had been assessed as having memory problems; however, they were supported to maintain their preferred routine of going out in the evenings and arrangements were made to support them with this goal.

This person was also the in-house Fire and Health & Safety officer. They worked with staff and had their own picture format to work from. This helped them identify risks or hazards in the way that they could understand. They were supported by a member of staff and assisted with fire evacuations and monthly health and safety checks. The registered manager told us this has helped this person’s esteem by being valued and included in the safety of their own home.

The home had recently had an audit of their medicines’ management by their pharmacist.  The report showed good compliance with medicines guidelines.  The registered manager shared knowledge with their medication auditor as they did not know the risks to using paraffin emollients. They said they would feed the information, which was taken from NICE/ CQC and NHS guidance, back to their pharmacist team.

Effective

People were satisfied about how their care and support was managed at Apple House and fed back to us that their consent was always agreed before any changes to their routine. Health and social care professionals also commented positively about the support people received at the home.

The home had a small staff team who felt well supported by the registered manager as well as the directors of the company.

Records showed that staff had regular supervision meetings and annual appraisal meetings with the registered manager. In these meetings they reflected on their work, the people living at Apple House, as well as training and development needs.

People were mostly able to make decisions for themselves about various aspects of their care and support. The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 in relation to supporting people wherever possible to make their own decisions. People’s consent had been documented in relation to areas such as care and treatment, medication, sharing information with professionals and having photographs taken. People told us that their consent was always gained and that staff respected their decisions.

Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act 2005 to make decisions in the person’s best interest.

Care plans recorded that people had been involved and supported as far as possible in making any decisions. Best interest decisions had been made on the basis of the least restrictive intervention necessary. Staff had all had training in MCA.

Staff encouraged and supported people to eat healthily and to be involved in shopping, cooking and budgeting. For example, one person’s cookery folder showed how staff had worked with them. Real time photos had been used as visual prompts to help the person remember what actions were needed to complete the task.

Caring

People and health and care professionals all told of how supportive the staff were at Apple House.

We discussed equality, diversity and human rights with the registered manager. Staff had a good understanding about treating people as individuals and ensuring they were given choice and their preferences respected. Staff received training in diversity, equality and inclusion.

Staff we spoke with had very good understanding of people, how to support them and knew of their goals as detailed within care plans. Each person had a communication plan and staff knew how to communicate with each individual.

Staff were aware of people’s preferences and respected their choices. People’s records included information about their personal circumstances, likes and dislikes and how they wished to be supported. For example, care plans referred to people’s preferred routines and how they liked to spend their day.

Responsive

An advocacy worker who had been engaged to work with one person commented; “It is refreshing to meet such a dedicated staff who have such a strong bond with the residents. It is very clear that (person’s name) enjoys life at Apple House, and this is solely due to the professionalism and genuine warmth of the staff to the residents. Believe me, there are not many homes that I would endorse without a second thought.”

Each person had an up to date personal care plan. The plans detailed people’s needs and how they should be supported. The plans gave good information about the whole person; their health, social, spiritual and emotional needs and identified goals set with that person. The plans were up to date and shared with the people living at the home so that they were fully involved in planning what they wanted to achieve in the future. For example, the registered manager told us that staff at Apple House and family had worked with one person with a mental health condition to remain stable for the past 18 months. The professionals involved had agreed to sign a support plan the person had written with the help of staff. This person had also with support written their own support plan to lower their stress levels, demonstrating the service encouraged people to contribute to planning their care.

People were enthusiastic to share their experience of the home and were happy for this report to reflect the full lives that they were able to enjoy because of the support and assistance of the staff.

Each person had varied, differing interests and the staff had worked with people to ensure people individuality was respected.

Well-led

The home was well-led by the registered manager who had worked at the home for many years. The directors of the company also took an active part in supporting the registered manger and people living at the home. They visited the home at least once a month to support the registered manager and also to review the performance of the service.

The company was a finalist in the National Learning Disabilities and Autism Awards 2017 for Employer of the year and also for 2018. The award for 2018 was in relation to the ‘Breaking Down Barriers’, which celebrates and recognises an individual or organisation who has worked to make sure people get clear information and are able to contribute their views and experiences.

One of the directors had been awarded ‘Director of the Year’ and had also been a finalist for a lifetime achievement award with a local initiative recognising women’s achievement in business. The Managing Director and the Director of Operations gave a seminar presentation for Westminster briefing, one of Europe’s leading political information, public affairs and policy communication specialist. This service feeds into the House magazine, the weekly business publication for the houses of parliament.

The registered manager had sought feedback from staff members with questionnaires asking about their working life. This was in addition to the support, supervision and appraisal given to all staff. The registered manager gave feedback in an open letter to the team to motivate and inspire the team.

— CQC

We would like to extend our warm congratulations to Jayne Jackson, Registered Manager at Apple House care home, and her team, for their hard work and total dedication to the individuals they support. What an amazing CQC report and a very well deserved rating of Good!

— Romaine Lawson, Director of Operations, Apple House Care Homes.

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Jane Montrose, Managing Director of Apple House care group, and Romaine Lawson, Director of Operations, were thrilled to be invited to speak at a Westminster Briefing in London last week.  The invitation followed the CQC ‘Outstanding’ rating of one of the group’s homes and focused on how leading services prepare for CQC inspections and met the updated CQC Assessment Framework.

In attendance were leaders of charitable trusts and housing associations, as well as heads of councils from around the country and other care provider heads, totalling twenty attendees. The discussions formed the first step in public policy debate which informs Westminster and Whitehall and also goes into the ‘House’ magazine which is distributed to Members in the Houses of Parliament.

A twenty-minute window was allotted to Jane and Romaine but this ran on to an hour as questions streamed in for them following their speech, culminating in the chair declaring, ‘One more question only!’

Romaine said after, “I am absolutely buzzing from this incredible experience, what a fascinating day it has been!”  Jane agreed, adding, “We hope to be invited by Westminster Briefing to speak again in the future.”

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Jane Montrose, Managing Director, and Romaine Lawson, Director of Operations of Apple House Ltd were thrilled to have accepted an invitation to London to be guest speakers at next week’s Westminster Briefing on ‘Care Home Inspections: Meeting the Updated CQC Assessment Framework.’

Joining Jane and Romaine in also speaking at the Westminster Briefing is Geraldine Strathdee OBE, former National Clinical Director for Mental Health and National Professional Advisor for the Care Quality Commission (CQC).

CQC’s new updated assessment framework for community and residential adult social care services comes into effect this winter. Discussed at the briefing will be a comprehensive overview of the guidance on care standards for care homes including best practice and changes to the key lines of enquiry.

Apple House care homes are proud to have joined John’s Campaign as part of our ethos of inclusion, of recognising the important role of family and friends to care residents’ wellbeing and personal identity.

“I quite like the title ‘Honoured Guests.  It reminds people, whether we are family or friends, that we are there as guests of the resident. This title also reinforces that staff and relatives should have one purpose, which is to support the person who is resident in the care home, and that their contribution is well-regarded.” — Professor Martin Green.

Within the publication, ‘Honoured Guests,’ Apple House care homes are referenced:

Care England is a registered charity and the leading representative body for independent care services in England.

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