Maple House Rehabilitation Unit

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our previous inspection we rated this key question good. At this inspection the rating has remained as good. This meant people were supported and treated with dignity and respect; and involved as partners in their care. Staff treated patients with compassion and kindness, and we observed staff taking the time to chat and discuss things with patients. Staff informed and involved families and carers appropriately. Staff spoke positively about the service and were encouraged to raise concerns and develop.

However, patients did not feel their individual needs and preferences were taken into account.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We observed staff interacting with patients in kind and compassionate ways, staff always greeted patients when they were passing, as well as engaging patients in meaningful conversations. Staff knew where patients were in their rehabilitation and discussions encouraged patients in their rehabilitation pathway. For example, discussing healthier eating habits and planning items to purchase on shopping trips as part of their self-catering programme.

Staff supported patients to understand their care, and patients were encouraged, where clinically appropriate, to attend their multi-disciplinary team meetings where their care and treatment was discussed with all professionals involved.

Staff we spoke with were aware of patients’ individual needs, including their personal, cultural, social and religious needs. The service supported individuals who wished to attend religious services and had an arrangement with a local care home, where patients could attend a non-denominational service at that location.

Staff were respectful of patients’ privacy and dignity and were careful to maintain confidentiality. Staff offered patients one to one discussions away from other patients, and did not discuss patients’ histories in communal areas.

We spoke with 8 patients during our inspection; their views of staff treatment were mixed. Most patients spoke positively about staff, and said they were kind and supportive, and patients shared that they enjoyed chatting with staff. However, some patients felt staff were not responsive to concerns raised, or to requests such as providing printed copies of policies. They also felt that observations were intrusive, and the reasoning behind them was not adequately explained. The manager of the service confirmed that concerns were received, and managers would meet with patients to discuss concerns, these meetings had minutes taken. The service identified concerns for themes and took action were possible.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences.

There was a garden space on the bottom floor, and access to the garden was through a programme of ‘movement breaks’. Patients went out to the garden ward by ward, which meant that access was limited, patients and carers told us that they were dissatisfied with this arrangement. This was raised during the previous inspection, however, staff confirmed that movement breaks needed to be completed ward by ward due to safeguarding concerns between patients on wards.

Patients we spoke with said they did not feel that there was a good range of choice for food and said they would like healthier options to choose from. However, there was a choice of food to meet the dietary requirements of religious and ethnic groups, and staff were aware of each patient’s individual allergies and intolerances to ensure their requirements were met.

The service also had a self-catering programme that was run by occupational therapy (OT). The programme had a graded system that gave patients a specified budget and expected actions, depending on what grade they were at, for example, planning the shopping list with OT, going shopping and then cooking a meal. The lowest grade budgeted one meal, and the highest grade budgeted for the week, and worked towards the individual rehabilitation pathway. However, patients told us they did not understand the grading system of the self-catering programme, which meant the different budgets for each patient appeared inequitable. These concerns were raised with the deputy manager, and the following day information leaflets on the programme were distributed around the wards, and copies were available to staff to better support understanding of both patients and staff.

Additional equipment for patients could be requested such as chairs which would adequately support individual’s needs. To meet each individual’s communication needs, the service also had access to translators and documents in accessible formats, such as easy read and communication aids such as mood cards. For one patient these were personalised, so the images reflected their preferred choice of images.

Staff supported patients to access local services. Patients told us they were aware of how to complain, but they were not always satisfied with the outcome of their concerns. Records showed that patients’ rights were read to them regularly.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients’ social needs were understood by the service, and individuals were supported to maintain and develop relationships with those close to them. Where appropriate, patients were able to visit their families and the service facilitated visits from family and friends, which patients spoke positively about.

Patients were supported to engage with the wider community through the service’s links with the local authority’s community and leisure hub, where patients could get involved with swimming sessions, circuit classes and lower mobility classes such as chair yoga.

Patients were also encouraged to get involved in volunteer and work opportunities. Some patients wished to be involved in paid work, and staff were supporting them to complete applications to become delivery drivers.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff displayed a good relationship with patients, engaging with them, supporting them and reducing the need for physical intervention. Staff we spoke with felt confident in supporting patients who were displaying heightened behaviours. Staff were trained in verbal de-escalation techniques and found these were often effective.

Staff were encouraged to identify and escalate changing risks to patients, for example, a support worker identified changes in a patient’s behaviour, recognising the different ways in which each individual may be communicating discomfort, pain or distress, including both verbal and non-verbal cues. The staff member escalated their concerns to the MDT who responded by reviewing the individual’s observations in a way that kept the patient and staff members supporting them safe, as a result, there was a reduction in incidents that required physical intervention.

Staff we spoke with felt confident to identify when a patient was deteriorating mentally or physically and worked to developed strong therapeutic relationships with patients to better recognise when a patient was experiencing a decline in their wellbeing.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

The staff that we spoke with spoke of a positive culture within the service, they felt supported, respected and valued by senior leaders. Staff were proud of the work that they did in the service, and the support they provided to both patients and their team. The service completed twice yearly satisfaction surveys, responses were mostly positive and where there were negative feelings identified the service had put measures in place such as celebration days, reviewing training and information boards.

Staff achievements and actions were recognised with a weekly feedback session, Shout Out Fridays, where staff and patients were invited to write a note of thanks or highlight successes, which were then added to a board in the entrance area. The provider also had staff awards, which highlighted when a member of staff reflected their visions and values.

Staff had regular appraisals, at the time of inspection the appraisal rate was at 95% for all staff members who required an appraisal. Staff also had regular supervision meetings and debriefs following incidents. The service also had access to a mental health first aider, which provided an alternative method for staff to raise concerns and access support.

Staff were encouraged to consider career development, and throughout the organisation there were examples of support workers progressing into more senior roles, or other supporting roles. For example, where there was an identified need for additional support, staff had been encouraged to develop roles such as the physical activities lead, and one support worker was being supported to provide psychology education sessions to patients. The service also offered apprenticeships through an external provider, and the service’s apprentice occupational therapist was currently accessing this.