• Mental Health
  • Independent mental health service

Archived: Apple Hill

Overall: Insufficient evidence to rate read more about inspection ratings

Henley Road, Hurley, Maidenhead, Berkshire, SL6 5LH (01628) 823200

Provided and run by:
Henley Healthcare Limited

Important: The provider of this service changed. See new profile

All Inspections

12 & 13 January 2016

During a routine inspection

Inspected but not rated

  • We found that some ward areas did not have environmental risk assessments in place. We also identified ligature risks that had been missed from the assessment completed. Some of the staff we spoke with were not able to recognise ligature risks in the areas where they worked.
  • We found example of interventions that met the definition of physical restraint and seclusion, the staff working in the hospital failed to recognise these and were not recording them appropriately.
  • Patients detained under the Mental Health Act are subject to additional restrictions and specific rights. We found that the staff working with detained patients had not been trained in the Mental Health Act. The hospital had identified this through audit but had failed to take any action to address this. The hospital had begun to admit patients before the staff team were trained.

However

  • All patients had good access to physical healthcare in addition to their mental health care.
  • There was a good standard of medicines management
  • Staff worked with patients in a caring way and took time to understand how patients communicate.
  • Care plans reflected people’s preferences and advanced decisions about care.

7 March 2014

During an inspection looking at part of the service

In this report the name of a registered manager appears who was not in post and not managing the regulated 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 of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

We found an effective system was implemented to identify, assess and manage risks at the location. Improvements were made to ensure people were safe and that there was effective and well-led care. Regular monitoring of the quality of the service was in place, which included gaining people's feedback and acting on it.

The provider had notified us, without delay, of relevant incidents via statutory notifications which occurred whilst services were provided.

23 December 2013

During an inspection in response to concerns

We did not speak with people who use the service at this inspection. This was because our inspection concerned only the management of the regulated activities.

We found the registered person had not reported applicable incidents to us without delay, as required by the regulation. This meant we could not effectively monitor the safety and quality of services provided to people.

22, 23 October 2013

During an inspection looking at part of the service

We spoke with several people who use the service about their care and welfare. One person told us 'I enjoy the music appreciation activity and we occasionally play beach ball but other than watching TV there is not a lot to do during the day'. The person told us they felt their well-being had improved since moving to Apple Hill and that they felt safe in the care home.

We were provided with a printed copy of a staff training audit completed on 20 September 2013 which included safeguarding topics. The provider told us would be doing another audit at the end of October 2013, to identify any updates for staff training that needed to be booked. There was a system in place to ensure that staff received regular training in safeguarding people who use the service.

Since our last inspection significant improvements were achieved by the provider in relation to requirements related to workers. This was due to the employment of a new administrator to the registered manager who had primary responsibility for arranging new staff interviews, checking documentation, assembling personnel files and auditing current employee files.

We found the provider still needed to improve their systems for monitoring medication refrigerator temperatures, screening people at risk of malnutrition and ensuring agency workers had information related to their employment on shifts at the location.

18 July 2013

During a routine inspection

When we spoke with people who use the service, they told us they were involved in decision making about different aspects of their care. For example, one person told us they had a choice of what they ate.

At lunch time, we saw some people who required support by staff with their meal. We observed staff who were helping people were delivering this care in a calm atmosphere and in a patient manner.

We spoke with 11 people who use the service. They told us they felt safe living at Apple Hill. However, at the time of the inspection, 22 staff had not received training by the provider regarding safeguarding. Many of these staff were workers who provided direct care to people, such as support workers or nurses.

We spoke with five members of staff who had all commenced working at the location within the previous seven months. All of the workers told us about the recruitment procedures they had undertaken. We looked at the recruitment documentation for eight workers. We saw that for all eight files, documents and some checks required by the regulation were missing from all of the files.

Regular audits of the quality and safety of service provision had been completed. However, the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

22 January 2013

During an inspection looking at part of the service

Some people who use the service had complex needs and were unable to tell us about their experiences. We used observation and other methods, to help assess the care which people received.

We saw the provider now had a comprehensive quality assurance system in place since our last visit. Regular audits including care plans, medication, health and safety and infection control were completed and the manager told us that these fed into the ongoing improvement plan.

People we spoke with were aware of the complaints system operated by the provider. One person told us they had raised a complaint and another person we spoke with told us they knew how to raise a complaint but had never raised concerns. Other people we spoke with provided feedback related to the care home but the feedback did not relate to the provider's complaints system.

We observed the records storage in four units of the care home. We observed people's care documentation were now kept securely and could be located promptly by staff when needed

15 November 2012

During an inspection looking at part of the service

We used a number of different methods to help us understand the experiences of people who use the service because some people had complex needs and they were unable to tell us their experiences. Other people who use the service were able to tell us about their experiences, but their feedback did not relate to the outcomes we inspected.

At a previous inspection on 2 October 2012 and 12 October 2012, we found the provider was non-compliant with four outcomes, and we took enforcement action against the provider.

At our last visit to the home, we observed use of language and terminology which implied the service was operating as a hospital rather than as a care home. During this inspection, we observed references to hospital terminology had been removed by the provider and staff we spoke with referred to the service as a care home.

We saw that culturally appropriate food was now being offered to people who use the service that preferred this. A new chef had been employed by the provider, the menus had been redesigned and we saw alternate diets were available for people who chose to have them.

Since our last inspection, the provider changed their method of assessing, managing, recording and investigating safeguarding matters. The provider had worked closely with the local authority and us to ensure people were safeguarded against abuse.

We found improvements were made by the provider to the management of people's medicines.

2, 12 October 2012

During an inspection looking at part of the service

During our inspection we spoke to eight people living at Apple Hill, six members of staff and four relatives of people living at Apple Hill. We also met and spoke to two managers (one who was appointed on 8 October 2012), one of the resident psychiatrists, the resident occupational therapist, a newly appointed operations manager and the nominated individual.

People told us that in the main they felt safe at Apple Hill and relatives told us that they thought that people had their basic care needs met by the service. One relative commented on individual members of staff who she said were 'lovely' and 'great'. However, we were told by three people living at Apple Hill that night staff 'send you to bed' and one person said 'staff take away your liberty'. People also told us about some of the restrictions placed upon them for example, not being able to go out when they chose to.

We found that people's care and treatment was not always delivered in accordance with their care plans. Care plans and risk assessments did not always take into account people's rights and did not always comply with the Mental Capacity Act 2005.

People told us they did not feel able to complain.

26 June 2012

During an inspection in response to concerns

We spoke to five people who lived at the service and one relative of a person who lived at the service. We spoke with 11 of the home's staff team including five care staff, four nurses, a psychologist and an occupational therapist. We also spoke to a visiting GP.

Most of the people we spoke to were happy with the care provided. When asked about the staff they said things like 'staff are good' and 'thumbs up'. A relative said "the staff are good, they let me know when my family member is unwell and if I can help".

People talked about their goals and the progress they had made. They said they received the care and support they needed.

We found that care was inconsistent and some people did not receive the care they needed as set out in their written care plans. We also found that people were not always safeguarded because staff had not been suitably trained, for example in restraint.

18 August 2011

During an inspection in response to concerns

People who use the service told us they had received a pre-admission assessment before arriving at Apple Hill and that on arrival they had been given an introduction to the facilities and staff at the service and a further assessment of needs. People said they had been asked about their likes, dislikes and preferences. One person said: 'The staff have always asked me about my needs, likes and dislikes.'

People told us they thought the food was very nice and met their needs and that any cultural preferences or allergies were well known by staff members and respected in the food provided to them. People said they were well informed about the choices of food available and were able to eat what and where they wanted to. The food was summarised by one person who said: '[It's] really nice and is always well presented and hot when it needs to be.'

People said that staff at Apple Hill were friendly and helpful and a member of staff was always available to provide assistance if they needed it. They said they felt comfortable in asking for assistance and had good relationships with those who provided one-to-one support for them.