This inspection took place on 7 and 8 November 2017. It was an announced visit to the service. This meant the service was given advance notice of the inspection dates.

Apple Hill is registered as a hospital for people who are detained under a section of the Mental Health Act 1983 but also provides accommodation for persons who require nursing or personal care. The location is made up of three separate units. One unit is the hospital unit. Two units provide a care home with nursing service which can accommodate up to thirty five people across the two units. At the time of the inspection there were thirty people living in the care home with nursing services and one person who was defined as receiving nursing care was being cared for on the hospital unit as they required the specialist support that the hospital unit offered. This report relates to the care home with nursing service only. There is a separate report for the Mental Health unit for an inspection that was carried out on the same dates.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. However the provider had recruited a manager who was registered with the Care Quality Commission as the registered manager for the location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The location was previously inspected in January 2016 but was not rated as there was insufficient evidence to rate it at that time.

At this inspection we found the service was providing safe, effective, caring and responsive care to people. The service was appropriately managed and audited. However improvements were required to people’s records to demonstrate the care given and action taken. We have made a recommendation to address this.

People and their relatives were happy with the care provided. They felt staff managed difficult situations with compassion and care. They felt adequate staff were provided. Staff were suitably recruited, inducted, trained and supported in their roles

Systems were in place to safeguard people. Risks to people were identified although some risk assessments and management plans lacked the detail to evidence how risks were managed.

People received their medicines as prescribed and had access to health professionals to meet their health needs. People’s nutritional needs were met and they were happy with the meals provided. In house activities were provided and community trips were planned and promoted.

The home was generally clean, maintained and equipment was regularly serviced. Infection control measures were in place to prevent cross infection.

People were involved and consented with on their day to day care. The service worked to the principles of the Mental Capacity Act 2005 but this was not always evident in some files viewed.

Staff were kind, caring and promoted people’s dignity, respect and independence. They recognised people’s religious and cultural needs and supported them to meet them.

People had care plans in place which identified their needs. Some improvements were required to ensure care plans were detailed and specific as to the care to be given. Staff had a good awareness of people’s needs and were responsive to changes in their behaviours and well- being.

People had access to information on how to raise concerns and were given the opportunity to raise concerns directly with management and at resident meetings. Issues raised were acted on. Families were able to give feedback on the running of the service to bring about improvements.

Peop

We rated Walbury ward as good because:

• Staff engaged positively with patients. We observed many positive and engaging interactions between staff and patients. Staff demonstrated a clear understanding of individual patient’s needs.
• Families and carers spoke positively about staff. They told us that staff listened to them and informed and involved them in decisions about the care and treatment. Carers told us that staff were accessible. The service kept them updated and provided information to help carers understand the current situation and treatment programmes. Carers had access to monthly carers’ support groups. Carers said they could not say enough good things about the service.
• Staff cared for patients in a clean, safe and well-maintained environment. Appropriate furnishings and equipment were available to support the patient group.
• Staff monitored patients’ physical healthcare and could access specialist physical health services when needed. A GP provided regular physical health monitoring. Staff accompanied and supported patients and their carers at outpatient appointments.
• The psychology department produced a detailed analysis of incidents involving patients, this highlighted risks, trends in behaviour and enabled staff to learn from incidents and offer care and treatment that was more effective and meaningful.
• The provider implemented robust governance procedures. A series of clinical quality audits were carried out, looking at key performance indicators on areas such as workforce, nutrition, cares planning. These were presented at monthly assurance meetings. This meant that the management team were able to receive assurance and apply clear controls to ensure the effective running of the service.

However:

• There was no occupational therapist currently at Apple Hill, the service had just recruited to this post. This meant that activities were limited particularly at the weekend.
• Mental capacity assessments were not consistent and lacked detail around physical interventions and there was a lack of understanding about the process of best interest decisions.