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.

• 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
        
    

The report summarises that most services they inspect give ‘good’ care to the people they support even though they may now been doing this with less money to pay for it.

It also states that adult care services have been able to maintain quality but that there is concern over the sustainability of adult services. Adult services have less money coming in and need to pay more money to staff members.

Some services are changing the way they provide the care to people to try and balance how they can do more with less.

Quality care provision is at the forefront of Apple House Ltd and we are working creatively and flexibly to adapt to the social care market. Our main principles of being committed to provide compassionate, professional care which enhances the quality of life for our residents and enables them to feel supported and valued within the community in which they live, remain our priority.

You can find more information on the report through the links provided below.

This information is also discussed through our residents, team and management team meetings so that we are kept abreast of national developments.

Link to – The State of Health Care and Adult Social Care in England 2015/16 – Summary

Link to – The State of Health Care and Adult Social Care in England 2015/16 – Easy Read

–– Romaine Lawson, Director of Operations