• Mental Health
  • Independent mental health service

Archived: Oaktree Manor

Overall: Good read more about inspection ratings

Heath Road, Tendring, Clacton On Sea, Essex, CO16 0BX (01255) 871017

Provided and run by:
Partnerships in Care (Oaktree) Limited

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Background to this inspection

Updated 11 May 2018

The provider for this location is Partnerships in Care (Oaktree) Limited and the corporate provider is Arcadia. As of 1 December 2016, there had been changes to the corporate provider as two organisations, Partnerships in Care and Priory Healthcare Limited, had merged.

Oaktree Manor has six low secure wards with 47 beds and offers inpatient care and treatment for people with a diagnosed learning disability, autism and mental health needs. Oaktree Manor has been registered with CQC since 13 December 2010. This location is registered to provide the following regulated activities: diagnostic and screening procedures; assessment or medical treatment for persons detained under the Mental Health Act 1983 and treatment of disease, disorder or injury.

The low secure wards at Oaktree Manor admit patients with a primary diagnosis of learning disabilities:

  • Cherry and Yellowwood wards – for women, with eight beds in Cherry ward and seven beds in Yellowwood ward
  • Maple and Pine wards – for men, with eight beds in each ward
  • Rowan and Redwood forensic wards – for men, with eight beds in each ward

There have been five inspections carried out at Oaktree Manor. The most recent being on 10-11 January 2017. When we last inspected, we rated Oaktree Manor as ‘requires improvement’ overall. The safe and responsive domains were rated as requires improvement; the effective, caring and well led domains were rated as good.

We told the provider they must take the following actions and issued a requirement notice for a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, Regulation 9, person centred care and Regulation 12, safe care and treatment.

  • The provider must ensure that staff reviews of patients in seclusion take place as per their policy and the Mental Health Act 1983 code of practice.
  • The provider must review their processes for planning and supporting patients towards their discharge from hospital.

The provider sent us a plan following the inspection detailing the actions they would take to address this. Following this inspection, we found further issues with the monitoring of patients in seclusion. However, significant progress had been made with planning and supporting patients towards their discharge.

We also said the provider should take certain actions:

  • The provider should review their recruitment and retention policies to reduce the number of staff vacancies.
  • The provider should ensure review their process for identifying, managing and removing ligature risks.
  • The provider should ensure that patients are effectively involved in debriefs following restraints.
  • The provider should ensure that patient care records systems are consistent and that staff have easy access.
  • The provider should ensure that electronic patient care records adequately reflect patients’ views.
  • The provider should review their systems for gaining and acting on feedback from patients regarding food.
  • The provider should review their communication systems with carers to ensure they receive regular updates on patients care as relevant.
  • The provider should review their systems in place to engage with staff at the hospital.
  • The provider should ensure that the hospital comply with reporting requirements for the Workforce Race Equality Standard.

Since February 2017, there have been three Care Quality Commission visits by mental health act reviewers. On Redwood and Rowan wards, concerns were raised about patients having to tell staff who they were calling before using the telephone and recording outcomes of patient leave. The provider had plans in place to address these issues.

Mrs Beatrice Nyamande is registered with the Care Quality Commission as the registered manager and as the controlled drugs accountable officer.

Overall inspection

Good

Updated 11 May 2018

We rated Oaktree Manor as good because:

  • Managers ensured effective systems were in place to measure the quality of the service. The provider had systems in place to help staff learn lessons from audits, complaints and incidents, through debriefs, team meetings, supervision and bulletins. Managers used these to ensure that sufficient staff were on duty and monitored mandatory training compliance and supervision. The provider operated a system to increase staffing on Fridays to facilitate staff training and administrative tasks without compromising patient care.
  • Safe staffing levels had been maintained on all wards. The provider had recruited additional staff since the last inspection and had reduced the use of agency workers from 45% to 30% in the last 12 months. Morale was good and staff teams supported each other effectively.
  • Staff compliance with mandatory training compliance was 90%. Staff had access to specialist training in autism and dialectical behavioural therapy. Staff had access to regular supervision.
  • Patients were offered debriefs shortly after incidents and periods of seclusion. They were also offered additional debriefs, 48 hours after the event by the psychologist and speech and language therapist.
  • Staff completed risk assessments for patients, which were thorough and linked to care plans. Staff completed good quality positive behavioural support plans for all patients, formulated with patient involvement.
  • Patients had access to a range of psychological therapies and to a range of activities such as attending a football match, animal care and art therapy.
  • Clinical staff completed audits and action was taken as a result. The provider held monthly safeguarding meetings with the local authority and police.
  • We observed staff treating patients with kindness, understanding and compassion. Staff understood patients’ needs and were motivated to provide high quality care. Carers and patients told us staff were helpful and polite. Patients had access to advocacy, including independent mental health advocates and independent mental capacity advocates, when needed.
  • The service had reviewed how they planned and supported patients towards their discharge from hospital. The service still experienced delayed discharges but had made consistent and considerable efforts to work with commissioners to reduce delays. Every patient had a discharge plan and staff supported patients to contact their community teams.

However:

  • Managers had not ensured that staff recognised or recorded that prone restraint techniques were utilised on patients to facilitate safe exits for staff from seclusion rooms. The provider had not ensured all patients received four hourly medical reviews during prolonged periods of seclusion.
  • The provider completed ligature risks assessments; however, these did not cover all ligature anchor points.
  • Not all patients could access outside space at will, particularly when staff were busy.
  • Staff’s use of physical interventions remained high across the service, although this was decreasing. Staff did not always update patient risk assessments after incidents.
  • Staff had not ensured all emergency equipment was safe for use. The emergency oxygen mask on Pine ward was out of date and had deflated.
  • Staff had not documented best interest decisions for two patients who lacked capacity.
  • There was a lack of patient involvement documented in some risk assessments.
  • The average length of stay for patients was 918 days across the service. This is higher than the national average of 554 days. The average length of stay on Yellowwood ward was 1150 days.
  • Patients stated that food was sometimes ‘greasy’ and choices, including vegetarian options, were limited.
  • Multi-faith rooms on the wards did not contain all the required literature or equipment.