Maple House Rehabilitation Unit

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our previous inspection we rated this key question requires improvement. At this inspection the rating has remained at requires improvement. Patient’s views and voice were not present in the risk assessments and care records, and there was limited evidence of discharge planning or goal setting. Records did not clearly identify risk across risk assessments and care plans, so when a risk was identified in the risk assessment it was not clear in the care record.

However, staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

We have not awarded this service a score for Effective.

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

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

During the inspection we reviewed 11 care records. Care plans had discharge plans in place, but for most patients they lacked detail, and potential discharge placements were not identified. This meant there was no goal for discharge until the patient was assessed as ready for discharge. For example, across Maple and Oak only 2 out of 6 records showed a clear discharge plan in place. Patients we spoke with did not feel informed or involved in any discharge planning. Also, MDT discussions were not always detailed in the care records. This was a breach of regulation 9: person-centre care.

Risk assessments were holistic and specific, covering mental, physical and social needs of the patients. However, the patient’s views and voice were missing from the records, which meant care plans were not as personalised as they could be. Patients that we spoke with were not aware of their rehabilitation goals, and what work could be completed to support them achieving this. This was a breach of regulation 9: person-centre care.

Care plans and risk assessments were updated regularly or when there was a change for the individual, however, there was little flow between care plans and risk assessments, which meant risks were not always clearly identified in care plans and vice versa.

However, the care plans did have activity timetables for patients, these activities were recovery orientated, and there was evidence of these activities being planned as well as carried out.

Patients also had crisis and contingency plans in place, including PBS (positive behaviour support) plans where relevant.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

The service model aimed to promote patient independence and successful reintegration into community living though encouraging social recovery and supporting this through psychological formulation.

Patients had access to a range of care and treatment interventions, which included medication and psychology where required. The service had a range of activities to support patients entering the community, including morning walks, swimming sessions, and baking which were co-ordinated by occupational therapy and the physical activity lead. The service also had a self-catering programme which aimed to support shopping and cooking skills, and psychoeducation sessions to help understanding and regulating emotions. Where appropriate, patients were also supported to access work, volunteer and education opportunities to help acquire living skills.

Staff ensured that patients had access to physical healthcare, with a weekly visit from a physical health lead who was able to assess patients and make required referrals. The service supported patients to attend specialist appointments, and as patients became more independent, they were able to attend appointments by themselves.

Staff participated in regular clinical audits, including care records, medicines management, security and training. These audits were used to identify areas of quality improvement, such as reviewing and increasing the available group activity sessions for patients and improving compliance with patients’ rights being read to them in compliance with section 132 of the Mental Health Act. The service also used the audit process to improve on the process itself, ensuring that the care plan audit assessed quality with a qualitative review, and increasing staff’s understanding of the external pharmacies high dose antipsychotic treatment audit to ensure there was better reflection between their audit and the service’s checks.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there was an occupational therapy assistant, with recruitment in process for an occupational therapist, there was also access to a clinical psychologist, and external pharmacy services.

Staff were experienced, qualified, and had the right skills and knowledge to meet the needs of the patient group. The service had an induction process which established the development for staff as well as checklists to ensure each element of training had been completed and signed off by the trainer and policies had been read. Agency staff also had a shorter checklist to be completed when they were new to the service.

Managers provided staff with supervision, including 1:1s, group sessions, debriefs, staff meetings and reflective practice, the service had a target to provide supervision every 6-8 weeks. 64% of staff engaged with supervision in line with this each month. The target for staff appraisals was 80%, when accounting for new starters to the service, compliance was at 95%.

The service had regular staff meetings on a 2 monthly basis, as well as specific meetings for nursing staff and senior support workers, the last meetings had all taken place in April 2026.

Mangers identified the learning needs of staff and provided them with the opportunities to develop their skills and knowledge. The service had a training manager who was able to source additional training for staff, which included apprenticeships, leadership and supervision training. Staff we spoke with said they had accessed training or were waiting to access training such as phlebotomy.

Managers dealt with poor staff performance promptly and effectively. The service had clear processes when there were concerns and could give examples of performance management.

We saw that 85% of staff had received training in the Mental Health Act. Staff we spoke with were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. The service had a Mental Health Act administrator to provide support and legal advice on the implementation of the Mental Health Act and its Code of Practice. They also completed a quarterly audit of a sample of files, and an annual audit of all files, which were then reported to the monthly hospital governance meeting, and the provider’s regional governance meetings. Learning had been identified from these audits and shared with staff to ensure paperwork was compliant.

The provider had relevant policies and procedures that reflected the most recent guidance. Records showed patients had their rights under the Mental Health Act explained to them in a way that they could understand, and repeated this as required. Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people.

The service had regular and effective multidisciplinary meetings, they took place weekly with relevant teams including external teams and the patients’ families invited to attend. Staff told us that there was good engagement from external teams such as social workers or care coordinators, they also confirmed that that working relationships between external teams were positive and they were responsive.

During the inspection, we observed a handover meeting between night staff and morning staff. The discussion covered all three wards, and an overview of each patient was given, which included presentation, medication compliance, and relevant physical health updates. Planned appointments and activities for the day were also discussed by staff.

The service also engaged with additional services where relevant to the patients, such as the police and local authority safeguarding teams. Staff said that relationships were effective, and good support was provided.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Ward activities helped to promote a healthy lifestyle for patients, and the groups available included morning walking groups, twice weekly swimming, and gym sessions. We observed that the morning walking group was well attended by patients, and on average 47% of patients engaged in over 10 hours of physical activity a month. An external substance misuse support service attended the service every two weeks, and patients could attend the sessions to access support for substance misuse. Smoking cessation support was also provided by the service, and all patients recently engaged in a smoke-free day.

The self-catering programme ran by occupational therapy also encouraged patients to shop healthier and patients told us they preferred this as they could choose healthier meals themselves. We also observed staff and patients discussing meals, and healthier options that they could cook themselves.

Patients that we spoke with told us that they did not like the meals provided by the service, as they were concerned they were unhealthy and the options were limited. Staff had engaged a patient representative in the service’s physical health group, and they had made recommendations on dietary requirements and healthy eating. A recent change to the menu was increasing protein intake in the menus.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The average median length of stay in the service in the service was approximately 3 years and varied across ward. Elm Ward had a shorter stay rehabilitation pathway with a median of 2.1 years average length of stay, Oak Ward had a median range of 3.3 years, and Maple Ward with a complex patient pathway had an average stay of 3.6 years.

Staff used recognised rating scales to assess and record severity and outcomes such as Health of the Nation Outcome Scales (HoNOS). Occupational therapy also used the Model of Human Occupation Screening Tool (MOHOST), to set goals for patients by evaluating patients’ participation in daily life.

Staff used technology to support patients. The service had introduced an electronic record system to centralise records, however elements of the system were still being developed, such as incorporating Mental Health Act records, which were recorded on paper separately.

Staff also had mobile phones to complete observations, and each bedroom had a QR code which could be scanned to show the observation had been completed. This was typically used when the patients were in their bedroom.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff we spoke with understood the importance of capacity, and would enable patients to make their own decisions. Staff were knowledgeable about patients who lacked capacity, for example, staff had prompts to support a patient’s personal care due to their reduced capacity.

Capacity assessments were completed by the service’s doctors, who recorded capacity to consent appropriately. Capacity was always assessed on a decision-specific basis, and staff were aware what the significant decisions were. Staff were encouraged to escalate concerns about a patient’s capacity to the nurse in charge.