CQC report explained · a residential care home
What the CQC found at Apple Tree House Residential Care Home Limited
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, June 2019
Rated Good overall; inspectors found safe, kind and personalised care, but the home's leadership and some records needed improvement.
This was an unannounced inspection on 5 June 2019 by one inspector. The inspector spoke with people, relatives, the manager and staff. They reviewed care records, medicines records, recruitment files, training records, complaints and other documents.
People told inspectors they felt safe and that staff were kind and respectful. Inspectors found that care was personalised, medicines were given safely and on time, health needs were supported, and people were helped to communicate, make choices and become more independent.
The main weaknesses were in management checks and records. Not every significant event had been reported to CQC promptly. Staff appraisals and competency checks were not all recorded, and some 'as and when required' medicines did not have written instructions. Action was taken during the inspection.
The home was rated Good overall and Good in Safe, Effective, Caring and Responsive. Well-led was rated Requires Improvement, meaning inspectors found that management systems were not always reliable enough, although they found no impact on people from the identified gaps.
People felt safe
People and relatives told inspectors they felt safe. Staff understood safeguarding procedures and there were enough staff to meet people's needs.
“People were safe and protected from avoidable harm. Legal requirements were met.” from the report
Kind and respectful staff
Inspectors found positive relationships between people and staff. Staff respected people's privacy, choices and dignity.
“People were supported and treated with dignity and respect; and involved as partners in their care.” from the report
Personalised communication
Staff understood how people communicated and used British Sign Language, pictorial information and easy-read formats where needed.
“People's communication needs were identified, and reasonable adjustments were made where appropriate around their learning disability and/or autism.” from the report
Support for independence
People were supported to take positive risks, develop skills, make choices and take part in activities and relationships.
“People were supported to focus on their independence in all areas of their lives.” from the report
Good health support
Staff worked with health professionals and helped people access services such as GPs and dentists. Inspectors found that people's health outcomes had improved.
“People's health outcomes had been improved.” from the report
Some medicines instructions were missing
needs fixingWritten protocols were not in place for all medicines given only when needed. The manager said these would be put in place after the inspection.
“Protocols for 'as and when required' medicines were not in place for all medicines to guide staff when medicines were required.” from the report
Staff checks and appraisals were not fully recorded
needs fixingNot all staff had received an appraisal, and competency checks had not always been recorded. The manager took action during the inspection.
“The registered manager had failed to complete annual appraisals with staff, record checks on staff competencies and ensure all 'as and when' required medication had a protocol for administration in place.” from the report
A notification was late
needs fixingOne significant event had not been reported to CQC in a timely way. The report says this was being considered outside the inspection process.
“Not all notifications of significant events were submitted to CQC in a timely manner.” from the report
Registration was being checked
minorThe report says there was a query about the home's current registration. This was also being looked at outside the inspection process.
“There was a query over the current registration of the service.” from the report
- 01Have all staff now had their annual appraisals and recorded competency checks?
- 02Do all medicines given 'as and when required' now have clear written protocols?
- 03What happened with the significant event that was not notified to CQC on time?
- 04Has the query about the home's current registration been resolved?
- 05How are management checks now used to make sure these issues do not happen again?
This was an unannounced inspection covering all five CQC questions, including the care provided and the home itself. This explanation was written from the published report of 28 June 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2017
Rated Good; inspectors found safe, caring and personalised support, with some minor record-keeping and staffing points to check.
The inspection was unannounced and took place on 27 January 2017. One inspector spoke with people living at the home, relatives, staff, the manager and a health care professional. They also looked at care records, medicines, staff files, the building and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines practice, suitable training, kind relationships and care plans that reflected people's needs and preferences.
The home had improved since the previous inspection in September 2015. Earlier concerns about medicines, legal safeguards and quality monitoring had been addressed, and the report says the requirements had been met.
Safe medicines
Medicines were stored, administered and checked safely. Staff were trained and their practice was observed before they administered medicines without supervision.
“Medicines were administered safely, and staff had received appropriate training on the administration of medicines.” from the report
Kind relationships
Inspectors saw staff being kind, considerate and supportive. People and relatives said staff genuinely cared and respected privacy and dignity.
“We saw very positive interactions between people who lived at the home and staff on the day of the inspection.” from the report
Personalised support
Care plans recorded people's life histories, interests, routines, preferences and support needs. People were supported to make choices and remain as independent as possible.
“People's care plans recorded information about their life history, their interests, the people who were important to them and their preferences and wishes for care.” from the report
Good management
The home had a registered manager, regular audits and opportunities for people, relatives and staff to give feedback. Earlier regulatory concerns had been addressed.
“We saw a variety of audits were being carried out to monitor the safety of the service and whether the service was meeting people's assessed needs.” from the report
Staffing at some times
needs fixingInspectors judged staffing levels sufficient, but one relative and a staff member said more staff could sometimes be helpful at night, at weekends or on particular occasions.
“However, another relative told us they felt there were occasions when the home would benefit from having more staff on duty, such as during the night and at weekends.” from the report
Repair records
minorThe home was maintained safely, but most repairs did not have a recorded completion date. The manager said this would be addressed.
“There was no record of when most repairs had been carried out.” from the report
Emergency evacuation plans
needs fixingPersonal emergency evacuation plans were in place, but some needed more information. Ask to see how this has been completed for the person you are considering.
“although some PEEPs required more information to be added.” from the report
Improvement records
minorAudits identified actions for improvement, but the records did not always show when those actions were completed.
“However, we noted there was no date to record when these identified actions had been completed.” from the report
- 01How many staff are on duty overnight and at weekends, and how do you add staff when someone needs extra support?
- 02Have all personal emergency evacuation plans been updated with the information each person needs?
- 03Are repairs now recorded with the date they were completed?
- 04How do you record that actions from quality audits have been completed?
- 05What activities are available for someone with particular interests, such as baking or playing dominoes?
This was an unannounced inspection of the overall service covering Safe, Effective, Caring, Responsive and Well-led, with records, medicines, staffing, premises and feedback reviewed. This explanation was written from the published report of 14 March 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Apple Tree House Residential Care Home Limited
3 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- June 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Apple Tree House Residential Care Home Limited →
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Apple Tree House Residential Care Home Limited →
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 8 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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