The Apple House Ltd Approach:

The world of management and strategic planning can be full of jargon-based terms and phrases, which can take the core meaning away from readers who want to see the direction and aims a company wants to work towards.

While it is crucial that our company has a clear strategic plan from directorship level, the methods which enable this plan to work through an operational route are key to achieving the common goal. This planning stage will assist the company forward through an ever-increasing demanding economy and climate.

For our Company, the aim is to protect the homes of the people we support and the jobs of the people whom we employ throughout our services.

An infographic is used to give an overview of our Operational Goal Planning.

–Romaine Lawson, Director of Operations, Apple House.

At Apple House care homes we want to assure you that we are working hard behind the scenes to keep safe the people entrusted to our care and our teams. PPE continues to be worn at all times in accordance with PHE best practice guidelines and we pay our team their full wages if they are called upon to isolate. We have collectively worked to reduce or eradicate staff movement between home ‘bubbles’ and are immensely proud of our teams for going above and beyond their normal working hours and duties to place a protective ring around each of our services, to keep others and themselves safe from Covid.

The vaccine roll-out is a monumental exercise, the likes of which has not been known in modern times. As yet we don’t know when our staff, or the people living in our services, will be called for their jab. But, we want to assure you that the work needed to ready us for our ‘turn’ is well underway. I applaud our local authority partners for their daily communication and the coordination looming to get the most vulnerable vaccinated, and ultimately you and us too. They never fail to keep us informed and to offer support to our sector.

Romaine, Director of Operations, attends weekly virtual meetings with the Clinical Commissioning Group and others in the varying care sectors, and yesterday, with Public Health England. We aspire to pioneer. We advocate for the people we support and keep updated with evolving guidance. We put forward ideas and action some of the ideas of others. Covid may have curbed life as we know it but our ambition is to lessen the impact on the people we support. To this aim we are managing to facilitate visiting, both at our homes in our new visiting pods, and at the homes of loved ones or community where possible and risk assessed.

Finally, thank you to every one of you who supports us – families, friends and professional colleagues, it’s really appreciated.

— Jane Montrose, Managing Director, Apple House care homes.

For the coming 2019/20 flu season we at Apple House are part of the Public Health England and NHS England & NHS Improvement campaign which focusses on the protective benefit of the flu vaccination using a “Shield” motif.

If you work with people in health or social care, you’re more likely to be exposed to flu – and to pass it on. That’s why the flu vaccination is free to all frontline health and social care workers and we promote this as the preferred route for all of our teams.

Being healthy won’t stop you getting flu or passing it on. The flu virus can infect anybody, and even someone with no visible symptoms is still at risk of passing the virus on. Flu virus strains change, so it’s important to have a flu jab every year ahead of the flu season. And remember, having a flu jab can’t give you the flu.

Help protect yourself, your family and the people you support. Get your free flu jab.

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

Now well and truly into the new year, I thought I’d take a moment to reflect on the last year and what a year it was for us all!

Redcroft’s transformation began exactly twelve months ago when the foundations were laid for the beautiful new wing which has been used to its fullest since completion in early summer, with a comprehensive schedule of pop-up shows. Last year saw the creation of an accessible garden, patios and activity cabin. Perhaps most exciting of all was CQC’s recognition of the hard work of our Redcroft team with their award of an Outstanding for ‘Responsive.’

For Summerwood there was new wood flooring, sprucing up, and a full itinerary of adventures which took advantage of the home’s excellent location twixt forest and sea. We were incredibly proud of Carly, Deputy Manager, who was an award finalist and of John, Registered Manager, who joined us in Birmingham as finalist for a national award.

Apple House care home became even more accessible with a posh new stair lift. Most exciting of all was having the honour of accompanying Mr G, resident at Apple, to Birmingham to receive his National Finalist certificate. Here he is proudly displaying the engraved pocket watch he received to mark his achievement (shared with his kind permission)…

What will 2019 bring? Already the new year has seen further enhancement at Redcroft with a fabulous new kitchen and range cooker installed last week. At Apple House care home we are busy considering plans for a new conservatory to enhance our current dining provision and patio areas. Summerwood too will see some fabulous enhancements during the next few months.

Finally, we welcome new team members and look forward to our annual party next month. Here at HQ we are already plotting to make 2019 a year of fun for our colleagues and those whom we support.

–Jane Montrose, Managing Director.

Historically, care homes and nursing homes followed the hospital model of rigid visiting times.  This in turn meant that families may not have been considered to be intrinsic in the planning of care pathways or, in fact, in the individual’s life inside a care environment.  Today, things are changing for the better but there is always more work to be done.

Apple House care homes embrace an ethos of inclusion.  Families and loved ones have a hugely crucial role to play and, as such, are our partners and never an inconvenience.

These are just some of the ways in which we include families of the individuals entrusted to our care:

• Decision making: From the moment that we receive a referral for a placement at our homes we establish communication with the individual’s family unless they do not wish to be involved in the assessment process.  This means that we invite the family and the individual to the home for an initial look at the facilities offered and to meet our team.  An open line of dialogue is created so that families feel empowered to ask any questions and to express concerns or wishes.  Often close family members advocate on behalf of their loved one or have worries about how the individual will adapt to their new home environment.  After all, change is scary for all of us and we understand that.  Only by being fully informed can families and their loved one make a decision that is right for them.
• Partnerships: We believe that families and friends are an invaluable source of information.  No-one knows an individual as well as those closest to them.  Insights and preferences, life history, hobbies and matters that are important to the individual can sometimes be shared with us more fully by family members, especially if their loved one finds verbal communication to be a challenge or if their memory is poor.  Memories are precious and we would like to learn about the memorable moments that are important to the person – all of this makes the individual who they are today. Working in partnership with families as well as the individual in care planning produces a more holistic and comprehensive pathway.
• Approachable: Communication is key.  Three words that summarise the entire partnership between ourselves and the loved ones of the individuals we support.  It is essential that strong communication is in place to form a bridge between families and staff teams.  That bridge helps to avoid rocky roads where anxiety and disharmony could take hold.  After all, it can be stressful and emotional entrusting the care and support of someone you love into the hands of others.  By us being approachable–letting families know that we are there to support them, that they can talk to us at any time–we hope to alleviate concerns, discuss expectations and to be friendly and flexible.
• Flexible: The people who live at Apple House homes are not living in our workplace.  We are working in their home.  They are free to invite their families and friends into their home for a cuppa or to enjoy their gardens with them.  We minimise rules about visiting to, for example,  the need to sign in which is a legal requirement, and to the consideration of others living alongside the individual.  There will always be a warm, genuine welcome from staff.  We have an ‘open door’ approach to visiting, just as we all expect within our own homes outside of care.
• Homely:  We work hard to ensure that Apple House homes are exactly that – homely!  To achieve this, we choose furnishings for our public areas such as lounges that are not clinical or generic in style.  We encourage the displaying of items and pictures that have meaning to the individuals who live there.  Our gardens are created and maintained with the help of those individuals who are able and wish to, for example our chickens are cared for by residents who collect the eggs and bake with them.  There are sensory areas and places to simply sit and be.  Where we are required to display certificates of registration, fire, health and safety etc, we endeavour to do so discretely.  Individuals are encouraged and empowered to decide how they wish their bedroom to look (and we’ve certainly painted some wild and varied colours!).
• Communication: We understand that it is not always possible to visit and so we ensure that alternative means of communication are accessible.  These include Skype video calls, email and telephone calls between individuals and their loved ones.
• Participation: Invitations are extended to families to events within the homes that are varied and regular.  These include invitations to birthday celebrations, BBQs, seasonal parties, special activities such as visiting owls and birds of prey and charity fund-raiser coffee mornings.

This list is not exhaustive – there are so many diverse ways of ensuring that we are family friendly.

–– Jane Montrose, Managing Director.

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“Care homes differ from other workplaces because they are not only places of work but are also homes for their residents. It is therefore important that they are pleasant places where the freedom and dignity of residents is respected, and where everyone’s health and safety is sensibly and effectively managed.” — HSE, Health and Safety in Care Homes, 2nd Edition.

“D, C and J were quite enthusiastic about the Health and Safety quiz and did their best to impress everyone with their knowledge. Some questions were a piece of cake for them, while others turned out to be a hard nut to crack! Fortunately, consultations were allowed and the spirit of co-operation proved stronger than the thrill of rivalry.

At the end of the day it’s all about team work at Apple House! Eventually, the collective effort paid off and the team passed the quiz with flying colours. This was a fun and informative house meeting, just like they always are. :-)” — Milosz, Deputy Manager, Apple House Care Home.

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In 2015, NHS England published reports highlighting the widespread inappropriate use of antipsychotics and other medicines used to treat mental illness in people with learning disabilities.  And, following these reports, NHS England led a ‘call to action’ which brought together representatives of professional and patient groups to make sure changes were made to these bad practices.

‘It is estimated that every day about 35,000 people with learning disabilities are prescribed psychotropic medicines when they do not have a diagnosed mental health condition, often to manage behaviour which is seen as challenging.’– NHS England

Thereafter, a three year strategy was founded which runs until 2019, centred upon finding other ways to ensure people receive the help that they need without the inappropriate use of medication.

Of course, medication is not bad per say.

Where medication is the right pathway for an individual, STOMP is about getting the right medicine, that medication reviews are regular and that individuals are involved and supported in decisions affecting them. It highlights the importance of inclusion of families and social care providers in supporting people.

STOMP is gaining momentum!

Here at Apple House care homes the principles of STOMP are carved deeply into our work and always have been.  However, we welcome this formalised approach which is raising awareness to a long history of inappropriate medication of people with learning disabilities.

Increasingly, health professionals and groups such as the British Association of Social Workers, Voluntary Organisations Disability Group, Royal College of Speech and Language Therapies, and Care Management Group, are joining the Royal Colleges of GPs, Nursing, Psychiatrists and the NHS, in pledging to uphold the ethos of STOMP.

Does this mean there is zero medication in Apple House care homes?

Of course medicine is still the appropriate choice for some people. What we believe, though, is that medication might be appropriate right now but that does not mean it needs to necessarily be a long term pathway.  Here, Jayne Jackson tells us just a few ways in which Apple House care home is embracing the STOMP project:

“If we give ‘as required’ medication, we immediately liaise with the mental health team so that we are all participating in the monitoring of the medication’s effectiveness and exploring why it was needed, what could and would work better to prevent the need for ‘as required’ medicine.

We use ‘flat mood’ charts as part of investigative work we are undertaking with Y and we noticed an increase in Y’s anxiety and darkening mood.  [This should help his psychiatric doctor understand if his low mood is linked to behaviour or mental health; this will also reflect on what medication he will be taking]

We know that sleeping well has been proven to keep Y’s mental health well and so we focus, with Y, on relaxation techniques, on ensuring Y’s environment is conducive to peace, calm and rest, and that Y is encouraged to talk about stresses or thoughts or emotions that might prevent a good night’s sleep.  Although guidelines are in place for the use of an as required medication, we have not needed to administer this for five years because we achieve results by more organic means.

We request referrals and screening tests – this ensures that underlying physical health is good and it also alerts us to any possible effects of reductions in medication.” — Jayne, Registered Manager, Apple House care home.

Communication is key!

Communication with the individual, with their mental health team, GP and community nurse. With family and outside agencies.  Together we ensure medication is regularly reviewed, side effects minimised and alternatives explored and used alongside or instead of medicine.

“We have a fantastic relationship with the people we support, their family and professionals.  We work as a team.” — Jayne, Registered Manager, Apple House care home.

What about alternatives to medicine?

We have previously reported, right here on our blog, about the extensive benefits of sensory stimulation via sensory rooms, sensory gardens and other creative means to defuse challenging behaviour.

As a ‘family friendly’ organisation, we encourage loved ones to be intrinsically involved unless an individual does not want this. We draw on their knowledge, the likes and dislikes and the past of the individual we support.  Triggers to mood change and behaviour escalation are identified and form the cement that underpins care plans and positive behaviour management.

“We as a provider carefully cherry-pick the best staff, the most compassionate and insightful team members who will look past the presenting behaviours and really see the individual.

Just today, at a senior team meeting, I introduced the team to an exciting new handbook called ‘Please Tell Me,’ by John’s Campaign of which we are members. This is a book by and for the people we support. It is their history, their present, and their future, as perceived by them and for them. Not only might it be cathartic to work on their book (with or without support as needed), but it provides a precious tool to record memories, to log events that have shaped them and thoughts that make up the person they are.

If we can see each person holistically, then together we can be more creative in finding alternative ways to medication to ensure life is full and pleasurable and safe.” –Jane Montrose, Managing Director, Apple House care homes.

 Here are some useful links for further reading:

Care Management Group, on STOMP: CLICK HERE

NHS England, on the STOMP pledge: CLICK HERE

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So we did!  #HappyTeam #FeedMe #MakingDreamsComeTrue

Romaine Lawson, Director of Operations for Apple House care home group, travelled to Birmingham to represent us.  Romaine said, “It was such an honour and privilege for Apple House to be finalists alongside national charities and city councils as one of only ten finalists in the country for the ‘Best Employer’ category.”

An honour indeed.  We are but a small company of dedicated professionals and to be a finalist for such a prestigious award has really rather taken us aback in the best possible way!

So, here’s keeping everything crossed.  To our team: we adore you.  Here’s to you!

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We would like to say a huge thank you to all of our nurse colleagues and our own nurse team members on this special celebration day.

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