• 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.

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.

🔊 Listen to this

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.”

🔊 Listen to this

Ms. Sutcliffe’s tweet followed a CQC national press release today announcing Summerwood care home’s ‘Outstanding’ rating, the highest rating possible.  Following the press release, Apple House Ltd were delighted to be contacted by local press taking up this good news story in an age when, all too often, the care sector is in the spotlight for more negative reasons.

Apple House will be holding a celebratory party at Summerwood next month.

Please follow us on social media: @AppleHouseLtd and https://www.facebook.com/AppleHouseCare/

• The public – people who use services, families and carers – know what high-quality care looks like and what they have the right to expect.
• Staff working within adult social care understand what high-quality care looks like and how they can contribute to delivering it.
• Providers of adult social care share a clear vision and commitment to providing high-quality care.
• Commissioners and funders of adult social care support the commissioning of high-quality care and high-quality integrated care.
• National bodies (including regulators and improvement agencies) support integrated working across the system to champion high-quality care.

🔊 Listen to this