CQC report explained · a nursing home
What the CQC found at Apple Hill
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unexplained injuries were not always reported, and observed physical restraint that was not shown to be necessary, lawful or proportionate. Risk assessments, fire drills, ligature checks and environmental safety measures were also not consistently effective.
- Effective?
- Requires improvement
- Care records did not always reflect people’s dietary and other needs, and staff understanding of the Mental Health Act and Mental Capacity Act varied. The home had enough specialist staff at the inspection, but there had been no occupational therapist from August 2022 to February 2023.
- Caring?
- Requires improvement
- People and relatives gave some positive feedback, but inspectors saw mixed staff interactions and found language in records that did not promote dignity or equality. Bedroom observation holes and some care arrangements also raised privacy concerns.
- Responsive?
- Requires improvement
- Care plans were not always personalised, holistic or recovery-focused. Visiting arrangements, communication support, activities, discharge planning and support with work, education and independent living skills did not consistently meet people’s needs.
- Well-led?
- Requires improvement
- Governance systems did not consistently identify, monitor or correct problems. Incident records and analysis were incomplete, and recruitment and agency staff records did not provide consistent assurance about safety and competence.
What inspectors found, June 2023
Requires Improvement; inspectors found serious safety and care-planning shortfalls, including unsafe restraint practices and risks that were not always managed.
Inspectors visited from 15th March to 30th March 2023. They reviewed records, observed care, spoke with people, relatives and staff, and considered information from ongoing monitoring and other sources.
The home was rated Requires Improvement in every area: Safe, Effective, Caring, Responsive and Well-led. Inspectors found an increased risk that people could be harmed because risks, restrictive practices, safeguarding concerns and fire safety were not always managed well.
There were also shortfalls in person-centred care, privacy, involvement in care planning, activities and record keeping. The home did have enough nursing staff, managed medicines safely, provided good physical healthcare and had some kind and supportive staff interactions.
The report says the home breached Regulations 9, 10, 12, 13 and 17. The home took some immediate action during or after the inspection, but the report says its overall systems were not effective enough to identify and fix problems promptly.
Medicines and nursing cover
The home had enough nursing staff and inspectors found that medicines were managed safely. Staff completed mandatory training, including basic life support.
“The service had enough nursing staff. Staff managed medicines safely. Staff completed mandatory training in essential skills including basic life support.” from the report
Some people felt safe
People who could express their views said they felt safe. Inspectors also saw some appropriate use of de-escalation techniques.
“People who were able to express their views told us they felt safe and we saw some examples where staff had used de-escalation techniques appropriately.” from the report
Physical healthcare
People could access GPs and a range of specialist healthcare services. Staff sought specialist advice where possible.
“People using the service had access to good physical healthcare. Where possible staff would seek specialist advice and input.” from the report
Positive care from some staff
People told inspectors that staff could be kind and compassionate. Inspectors also saw examples of patient support with meals and consent being sought.
“People told us staff were caring and compassionate.” from the report
Unsafe restraint and safeguarding
seriousInspectors found unexplained injuries were not always reported to safeguarding authorities. They also observed physical restraint without evidence that it was necessary, lawful, in the person’s best interests or proportionate.
“We observed a staff member use a form of physical restraint on a person where evidence did not demonstrate it was necessary, lawfully justified, in the person’s best interest and in a safe and proportionate way.” from the report
Risk records and fire safety
seriousRisk assessments did not always give clear, current guidance. Fire drills did not robustly test evacuation, and some ligature risks and environmental hazards had not been properly identified or managed.
“Systems to assess, monitor and mitigate risks to people’s health, safety and welfare of people using the service had not been effective. This placed people at increased risk of harm.” from the report
Privacy and dignity
seriousInspectors found disrespectful language in records, mixed-quality staff interactions and bedroom observation holes that could allow others to look into rooms. Some care was delivered in communal areas without enough consideration of privacy.
“The service did not always ensure people were consistently treated with dignity and respect.” from the report
Care planning and activities
seriousCare plans did not consistently show people’s involvement or reflect their full needs. Inspectors also found limited and insufficiently personalised activities, including limited support with rehabilitation goals.
“The service did not consistently provide personalised care and support to meet people's holistic needs.” from the report
Weak governance and records
seriousIncident and accident records were incomplete and analysis did not always identify patterns or learning. Recruitment and agency staff records also lacked important information.
“Systems were not effectively implemented to monitor events and learn lessons and continually improve the service.” from the report
Visiting restrictions
needs fixingSome relatives found booking rules and limits on visit times, locations and duration made visiting difficult. The home did not do everything practicable to meet people’s visiting preferences and needs.
“The home had restrictions in place around the times and duration people could receive visitors.” from the report
- 01What action has been taken to ensure restraint is only used when necessary, lawful, proportionate and carried out by appropriately trained staff?
- 02How are unexplained injuries and safeguarding concerns now recorded, reported and reviewed?
- 03What has been done to correct the fire evacuation arrangements and identify and manage all ligature and environmental risks?
- 04How will you involve my relative and our family in care plans, risk assessments and best-interest decisions?
- 05What activities and rehabilitation support are now available, including opportunities outside the home, work, education and independent living skills?
This was a comprehensive inspection covering all five key questions, so all five ratings were assessed during the inspection visit. This explanation was written from the published report of 20 June 2023 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. The report was longer than we could read in one go; the later sections may not be reflected.
What inspectors found, January 2018
Rated Good; inspectors found kind, safe care, but activities and mental capacity records needed improvement.
Inspectors visited on 7 and 8 November 2017. They visited the ward, observed care and mealtimes, spoke with carers and staff, reviewed five care records, checked medicines and examined policies and other documents.
The report covers Walbury ward, which provides long-term rehabilitation for up to seven men with mental health needs. Inspectors found the ward clean, safe and well maintained. Staff understood patients’ needs and treated them with kindness and respect.
All five areas were rated Good: safe, effective, caring, responsive and well-led. However, there was no occupational therapist at the time of the visit, so activities were limited, especially at weekends. Mental capacity assessments and best-interest decisions were not always recorded clearly or consistently.
Kind and respectful care
Inspectors saw staff respond calmly to distress and show a good understanding of patients as individuals. Carers also gave very positive feedback.
“We observed many positive and engaging interactions between staff and patients.” from the report
Good communication with families
Carers said they received regular updates and were involved in decisions about care and treatment. They could also attend monthly support groups.
“Carers spoke about very good communication and being informed and updated on a regular basis.” from the report
Safe environment and staffing
The ward was exceptionally clean and well maintained. Inspectors found enough suitably trained staff and regular checks of environmental risks.
“The ward and surrounding areas were exceptionally clean, spacious and well maintained.” from the report
Learning from incidents
The psychology team analysed incidents to identify triggers and risks. This information was used to improve care plans and support.
“This useful tool identified triggers and assisted staff when compiling care plans and management of care in a meaningful way with patients.” from the report
Strong management checks
Managers used training records, audits and monthly performance information to monitor areas such as care planning, nutrition, staffing and incidents.
“The provider implemented robust governance procedures.” from the report
Limited activities
needs fixingThere was no occupational therapist at the time of inspection, although the service had recruited to the post. Activities were particularly limited at weekends.
“There was no occupational therapist currently at Apple Hill, the service had just recruited to this post.” from the report
Mental capacity records
needs fixingMental capacity assessments did not always explain the decision, the person’s needs or how they had been supported to understand. Staff also did not show a consistent understanding of best-interest decisions.
“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.” from the report
Staff retention concerns
minorSome carers were worried about the number of management staff and the retention of ward staff. They also reported difficulties with laundry and missing personal clothing.
“Some carers told us that they were concerned about the high level of management staff and were concerned about staff retention of ward staff.” from the report
- 01How many occupational therapy sessions and weekend activities are now available?
- 02How are mental capacity assessments recorded now, especially for physical health treatment?
- 03How do you make sure best-interest decisions are properly discussed and recorded?
- 04What has been done about carers’ concerns over staff retention and missing clothing?
- 05How will families receive updates and take part in care planning?
This was a comprehensive inspection of the long-stay and rehabilitation mental health ward, Walbury; the adult social care team wrote a separate report for the residential care service. This explanation was written from the published report of 8 January 2018 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 Hill
3 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- June 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2018GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2016
Registered with the Care Quality Commission on 3 October 2016.
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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