CQC report explained · a residential care home
What the CQC found at Apple Trees Care & Reablement Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2021
Rated Requires Improvement; inspectors found kind, respectful care, but night staffing, risk management and oversight needed improvement.
This was an unannounced focused inspection on 1 March 2021. Inspectors looked at Safe, Caring and Well-led, partly because of concerns about staffing after one unit became a transitional care setting for people recovering from COVID-19.
The home was caring, and people were treated with respect and dignity. People and relatives were involved in care planning, and staff supported people's choices and independence. Infection control arrangements were also judged suitable.
There were important safety concerns. Night staffing did not always meet people's needs, some risk information was inconsistent, falls were not analysed well enough, and minor medicines errors were not always reported. The home was rated Requires Improvement overall, with Safe and Well-led also rated Requires Improvement.
The overall rating had fallen from Good at the previous inspection in 2019. Caring had fallen from Outstanding to Good. Effective and Responsive were not assessed during this focused inspection.
Kind and respectful care
Inspectors saw positive caring interactions. People and relatives said staff listened to their views and treated them respectfully.
“People and their relatives told us the staff team treated them with care and respect, and their views on their care were listened to.” from the report
Choice and independence
People were involved in decisions about daily care, including when to get up, go to bed and receive personal care. Staff supported privacy and independence.
“People were able to spend time privately when they wished.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infection, including COVID-19 risks.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Partnership working
Staff worked with community nurses and specialist services. Inspectors found evidence that a communication book had improved contact with community nurses.
“There was evidence to show this had been a successful initiative.” from the report
Night staffing
seriousStaff raised concerns that there were not always enough people working at night to meet residents' needs. Staff said care could feel rushed, although dedicated roster support was put in place after the inspection.
“The staffing levels at night did not always meet the needs of people at the service.” from the report
Falls and risk information
seriousSome care plans gave different levels of risk for the same person. The home also did not analyse falls well enough to identify when they were most likely to happen.
“There was a lack of analysis of the time of day when the most falls occurred.” from the report
Medicines reporting
needs fixingStaff said minor medicines errors were sometimes not reported because they were busy and rushed. The manager said this would be addressed through meetings and supervision.
“Staff also told us that on occasions minor medicines errors were not always reported as they were too busy and rushed.” from the report
Care plan and diet guidance
seriousInspectors found inconsistent risk information in care plans. They also saw a person given a normal diet despite advice for a soft diet, without finding communication showing that the change had been agreed as safe.
“At lunch time we observed this person was given a normal diet.” from the report
Quality oversight
needs fixingThe home's monitoring systems did not identify the concerns about falls, night-time staffing or whether the dependency tool was being used to set safe staffing levels.
“However, the processes had not highlighted the concerns we found around the number of falls and themes and trends, and the staff's concerns around the falls at night.” from the report
- 01What dedicated staffing is now in place between 7pm and 7am, and how do you check it meets each person's needs?
- 02What changes have you made to analyse falls, especially during the periods when falls were most common?
- 03How do you make sure risk assessments and care plans give consistent instructions to staff?
- 04How are all medicines errors, including minor errors, reported, reviewed and acted on?
- 05How do you make sure advice from speech and language therapists is followed or formally changed when it is not working?
This was a focused inspection of Safe, Caring and Well-led; Effective and Responsive were not assessed, and the inspection was prompted by concerns about staffing. This explanation was written from the published report of 20 April 2021 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, November 2020
Inspected but not rated; inspectors found good infection prevention and control measures during the pandemic.
This was an announced, targeted inspection on 22 October 2020. Inspectors looked only at infection prevention and control because the home was being used for people discharged from hospital with a positive Covid-19 status.
Inspectors found a separate unit for people admitted with Covid-19. It had its own access, and staff working there did not work in other parts of the home. The home also had enhanced cleaning, extra handwashing equipment, testing and personal protective equipment arrangements.
People could use a Covid-secure garden area. Staff had extra infection control training, and the infection prevention and control policy was up to date.
The home was inspected but not rated. This means the inspection did not give an overall quality rating or assess all five areas of care.
Separate Covid-19 area
The home had a dedicated unit with en-suite rooms for people admitted with Covid-19. It could be separated from the rest of the home, helping reduce infection spread.
“The service had developed a dedicated unit with en-suite rooms to care safely for people who were admitted to the service with Covid-19.” from the report
Enhanced cleaning and equipment
The home had extra cleaning of frequently touched areas and additional equipment to support infection control.
“Enhanced cleaning schedules including regular cleaning of touch areas such as handrails and door handles were in place.” from the report
Safer staff working arrangements
Staff did not work across different floors or in other care settings. They had extra training in infection prevention and control and the use of protective equipment.
“Staff employed by the service did not work in any other care setting.” from the report
Outdoor access
People who tested positive for Covid-19 could still use a garden area designed to reduce risk to others.
“People were able to access the garden which had a specific 'covid secure' garden area” from the report
Inspectors raised no specific concerns in this report.
- 01How are the separate Covid-19 unit and its access arrangements being used now?
- 02How often are touch areas such as handrails and door handles cleaned, and how is this checked?
- 03What infection prevention and control training have staff received since this inspection?
- 04Do staff still avoid working in other care settings and across different floors?
- 05How can residents access outdoor space if they have an infection or need to isolate?
This was a targeted inspection of infection prevention and control only; the home was inspected but not rated for the other areas of care. This explanation was written from the published report of 10 November 2020 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 Trees Care & Reablement Centre
3 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- April 2021Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Apple Trees Care & Reablement Centre →
- November 2020Inspected but not ratedSafe: Inspected but not rated
Read what inspectors found at Apple Trees Care & Reablement Centre →
- May 2019Goodstayed GoodSafe: GoodCaring: OutstandingWell-led: Good
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Registered with the Care Quality Commission on 10 March 2014.
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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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.