• 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

All Inspections

13,14 and 26 February 2018

During a routine inspection

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.

10 to 11 January 2017

During a routine inspection

We rated Oaktree Manor as requires improvement because:

  • Staff did not always undertake reviews of patients in seclusion as per the provider’s policy and Mental Health Act 1983 code of practice. For example, doctors did not always review patients within one hour of the seclusion starting. Seclusion is the supervised confinement of a patient in a room, which may be locked. Its sole aim is to contain severely disturbed behaviour which is likely to cause harm to others.
  • The provider had challenges with moving patients out of the hospital. The average length of stay for patients (now discharged) was 826 days, significantly longer than the national average of 554 days. Pine ward’s average length of stay for patients was the highest with 1410 days.
  • The provider had difficulties recruiting permanent nursing and healthcare workers. Staff vacancies had significantly increased since our last inspection.
  • The number of staff restraints of patients had increased since our last inspection and several patients told us they did not like restraints taking place on the wards.
  • The provider still had high and low-level ligature points across the hospital and lack of anti-barricade protection on some patient area doors which posed risks to patients with self-harming behaviours. Staff still could not easily observe patients on Rowan and Redwood wards due to the ward layout.
  • Staff held patient records in paper and electronic files and some records were not easily accessible. Electronic records did not fully capture patients’ involvement and views particularly on Maple and Pine wards.
  • Several patients told us they did not like the food and there was not enough variety. They said they wanted more meaningful activities.
  • Carers told us they did not always get updates from staff about the patient’s care.
  • The provider identified they had not developed their systems to address the workforce race equality standards.

However:

  • Most patients said they were getting a good service from staff and that staff helped them with their care and treatment and most carers agreed. Patients were encouraged to give feedback on the service and to influence it.
  • Staff were respectful and caring towards patients during their interactions, and they had a good understanding of patients’ needs.
  • Staff were proud of their work and had good morale. Staff said they worked well in their multidisciplinary teams. They said they were supported in their role and had opportunities to learn and develop relevant skills for their work.
  • The provider had increased the number of female staff working on Yellowwood and Cherry wards and had increased their staffing establishment across the wards. They contracted locum staff to ensure consistency of care for patients and address staffing shortfalls.
  • Staff had developed a restrictive practices group to reduce blanket rules for patients occurring in the hospital. Staff completed comprehensive assessments and care plans for patients.
  • A speech and language therapist developed communication plans for patients which the provider checked to ensure they met best practice standards.
  • The hospital had a range of facilities. Staff gave examples of how they supported patients’ diverse needs.
  • The provider had a range of governance systems to assess and monitor the quality of the service involving staff, patients and others.
  • The hospital met 87% of the quality network for forensic mental health services low secure standards, which had increased since our last visit.

21 to 22 October 2015

During a routine inspection

We rated this hospital overall as ‘good’ because:

  • governance processes were in place to assess and monitor the quality of the service
  • managers had access to dashboards which tracked incidents and other relevant data for their ward and hospital
  • daily senior management team meetings took place to review the latest incidents and issues for future planning
  • patients had assessments and care plans
  • assessments used nationally recognised assessment tools and staff provided a range of therapeutic interventions in line with National Institute for Health and Care Excellence (NICE) guidelines
  • most patients were positive about the support they received on the ward
  • patients had a range of opportunities to influence the service and their care and treatment
  • the provider had identified care pathways
  • most admissions were planned and staff assessed patients promptly following referrals
  • patients’ diverse needs were being met and they had access to a range of hospital on site facilities and were supported as appropriate to have community resources as appropriate
  • most staff reported good morale, multidisciplinary team working and support from line managers
  • the hospital was a member of the quality network for forensic mental health services and had received peer led reviews to compare themselves with other similar units and national standards
  • the provider had considered the needs of patients with a learning disability and autism and identified areas of compliance and improvement in reference to the ‘Winterbourne View Interim Report’
  • staff conducted care and treatment reviews with commissioners such as NHS England
  • education courses had approved ASDAN (a national charity) programmes and qualifications that grow people’s skills for learning, employment and for life.

However:

  • high and low-level ligature points across the hospital and lack of anti-barricade protection on some patient area doors posed risks to patients with self-harming behaviours
  • the service had several staffing issues, including the percentage of female staff working on the women’s wards sometimes falling below 50%
  • only 68% of bank staff had completed the provider’s mandatory training, falling below the provider’s target level
  • staff did not always detail physical patient observation checks in patients’ records after they administered rapid tranquilisation medication
  • some Mental Health Act 1983 documents and Mental Capacity Act 2005 were not locatable in patients' records; including an assessment for patient who was having specific staff intervention for a physical health test
  • Pine ward seclusion room did not have easy access to a bathroom which could affect patients’ privacy and dignity
  • the hospital staff survey results for 2015 were lower than the corporate provider’s average.

17 February 2014

During a routine inspection

Some people living at Oaktree Manor had complex needs and were unable to discuss their care with us which meant they could not tell us their experiences. We saw from gestures and facial expressions that they were happy. From some general conversations it was evident people were satisfied with their life at Oaktree Manor. One person told us: “I do voluntary work tidying up a nature reserve.” People also made positive comments about the staff. One person said: “Staff treat me fine” and someone else told us: “All (staff) have been helpful, I’ve got no problems.”

Staff knew people well and they were able to tell us about their specific needs. We saw that there were respectful interactions between members of staff and people living in Oaktree Manor.

Staff listened to people and provided care and support in ways that met their needs and took into account their individual preferences.

People living at Oaktree Manor had the benefit of an environment that was comfortable and well maintained.

There were systems in place to support and supervise staff and to provide them with the training they needed. This ensured that they had the skills and knowledge to provide safe and effective care.

Oaktree Manor was well run by a competent manager and there were effective systems in place to record information related to the management of the service as well as people’s personal information.

6 March 2013

During a routine inspection

During our inspection of the service on 6 March 2013, we were accompanied by a Mental Health Act Commissioner who had carried out previous Mental Health Act 1983 monitoring visits.

Staff showed a good understanding of people’s needs and preferences and we noted that staff treated them with respect.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff. People told us that day-to-day life was “...all right.” One person said they liked to watch football and play cards. Someone told us: “I went out yesterday for a meal” and “I go out at weekends.”

We saw good interactions between staff and people in the Oaktree Centre where they attended activity sessions. People said they liked the staff and one person told us their named nurse was “... really nice.”

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the needs of the people using the service.

There had been improvements to the environment to make it more homely and we saw that further improvements were in progress. One ward, Gate House, was due to be redecorated in the near future but we noted that there were some areas that could be improved by cleaning.

29 August 2011

During a routine inspection

Some of the people who use this service have difficulty understanding and responding to verbal communication. During our visit we spoke with a small group of patients and were able to hold a conversation with three people. Most of the information about people's experiences of Oaktree Manor was gathered through our observations.

We saw that people looked well cared for and that staff provided care in a safe way. People told us that their care was discussed with them.

We saw that people were supported to be involved in day to day life at Oaktree Manor.

We saw staff were respectful when speaking with people, taking time to explain what they were going to do.

We saw from the records that staff supported them to manage their health care needs.

People told us they had a choice of food and had been able to influence the meals that were provided and that the food was much improved.

People we spoke with told us that they were sometimes angry with others and at these times staff helped and supported them.

We saw that people benefited from a safe and pleasant environment. One person told us that they could have their own television and music system.

People told us that they liked living at the hospital. One person said 'It's much better than the last place.'

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.