The Care Quality Commission
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Uplands Independent Hospital

Overall: Requires improvement read more about inspection ratings

61 Park Lane, Fareham, Hampshire, PO16 7HH (01329) 221817

Provided and run by:
Coveberry Limited

All Inspections

19 October 2022 and 20 October 2022

During an inspection looking at part of the service

Our rating of this location improved. We rated it as requires improvement.

The Care Quality Commission conducted an unannounced inspection of Uplands Independent Hospital on 19 and 20 October 2022 to check that the improvements detailed in the warning notice served following our inspection January 2022 had been made. In January 2022 we rated the hospital inadequate and placed it in special measures.

On 28 and 29 June 2022 we undertook a focussed inspection to check whether improvements had been made. We found that the provider had made some improvements but needed more time for improvements to be fully implemented. The provider gave us assurance that they would continue to improve. We decided to give the provider more time to make the required improvements but to monitor it closely. The hospital remained in special measures and continued to be rated inadequate.

During this inspection we saw that the provider had maintained the improvements we found in June 2022 and had continued to make progress with the areas that required improvement outlined in their action plan. They had started work to improve the environment, installed a new fire alarm system, ensured staff undertook mandatory training and commenced recruitment for a range of clinicians so they could offer a full multidisciplinary team input to patient care. Whilst the provider had developed a comprehensive rehabilitation and recovery care model this had not yet been fully implemented or embedded within the services practice. Staff had involved patients in developing the new model of care and we also saw that staff were more engaged with patients; offering more one to one engagement time. Senior managers were visible across the hospital and staff felt they were approachable, listened to them and acted on their concerns. However, the provider was clear that they still had actions to complete and that they needed to continue embedding the improvements they had already made.

Our rating of this location improved. We rated it as requires improvement because:

At this inspection we found:

  • The provider had not yet fully addressed all of the improvements to the environment identified in their action plan. For example, some ligature anchor points remained although these could have been removed and these were not all included in the ligature risk assessment. Not all patients had access to a nurse call system in their bedrooms so would be unable to call for help if they needed to.
  • The provider had reduced the number of registered nurses on duty, since our last inspection, as the number of patients admitted to the hospital had reduced. However, the staffing ladder used to identify the number of registered nurses required on the ward focussed more on the number of patients rather than the care they needed.
  • Care plans were not as person centred or recovery focused as they could have been. For example, they did not detail how patients could gain the skills needed to live in the community. Staff did not always document how patients had been involved, in care planning, recorded best interest decisions for patients that lacked capacity or if they had understood changes to their treatment.
  • Staff told us that they sometimes had to cancel escorted community leave because of staffing numbers.
  • We found that one medication record did not have a completed section 62(1) urgent treatment form attached to it. A section 62(1) urgent treatment form is needed to authorise treatment which has not been agreed by the patient when a patient does not or cannot consent and treatment has been agreed by a second opinion appointed doctor.
  • The provider did not actively seek feedback from families and carers about the service.
  • The female lounge was a long distance from the main areas of the hospital so not easy for female patients to access.
  • The provider was in the early stages of implementing a new governance process across all of its services. Managers at Uplands were still introducing this structure so not all governance process were working effectively.
  • The provider had identified a new rehabilitation and recovery focused model of care, but this had not been fully implemented at the time of the inspection.

However:

  • The ward remained clean and there were maintenance plans in place to improve the environment.
  • The hospital had reduced the number of agency staff it used. All staff received an induction before working at the hospital. The service held regular multidisciplinary team (MDT) meetings and was actively recruiting to ensure they had a complete MDT available to the patients.
  • The care plans in place met and identified patients’ physical and mental health needs. Staff supported patients to access physical health care. Staff used rating scales to identify and meet patients’ needs. All patients’ records we reviewed had a positive behaviour support plan in place, which staff understood, and a discharge plan.
  • Staff ensured that the clinic room was fully equipped and clean and the provider had introduced an electronic prescription system to reduce errors.
  • Interactions we witnessed between patients and staff were caring and respectful, patients told us they felt safe in the hospital and knew how to complain. Staff completed a daily risk assessment for each patient and reported incidents appropriately.
  • The provider had opened a female lounge and was preparing a room to be used as a gym for the patients.
  • There was a new hospital director in post and the provider had agreed a long hand over period with the interim hospital director to ensure consistency.

As a result of the improvements, we will remove the hospital from special measures.

28 and 29 June 2022

During an inspection looking at part of the service

Uplands Independent Hospital provides long stay and rehabilitation mental health services to people aged over 18.

On 28 and 29 June 2022 the Care Quality Commission undertook an unannounced focussed inspection at Uplands Independent Hospital, to look at whether required improvements identified at our last inspection (11/12 January 2022), had been made. Following that inspection, we served the provider with a Warning Notice because we found that significant improvement was needed to ensure patients received safe care. The Warning Notice required the provider to make immediate improvements to meet the legal requirements set out in the Health and Social Care Act.

In order to meet those requirements, we told the provider that it must ensure that, robust risk assessments were completed, medicine systems were managed safely, care plans were person centred and clearly identified patient’s needs, appropriate and timely physical health care for all patients was taking place, the environment and equipment were safe and clean, there were enough suitably qualified and competent staff, and that robust governance arrangements were in place to assess, monitor and improve the safety and quality of the service provided.

In addition to the improvements identified in the Warning Notice, we also told the provider it must ensure that, a recovery focused rehabilitation model was developed to support patients in their pathway to discharge, patients on high dose antipsychotic therapy (HDAT) had their physical health monitored appropriately, patients were treated with compassion and respect, staff completed mandatory training and received regular supervision, Mental Health Act 1983 T2 and T3 forms were up to date, and Mental Health Act 1983 S132 rights were explained to patients regularly and a process was in place to monitor this.

The provider submitted an action plan to demonstrate how they were going to meet the required improvements set out in the Warning Notice along with the other improvements required. We rated the service inadequate in all key questions and overall, and placed into special measures.

During this inspection, we found that not all the required improvements identified in the Warning Notice had been met. However, we identified that a number of positive steps had been taken since our last inspection and it was evident that the hospital was on a transitional phase, trying to implement improvements and to review their philosophy and working practices. Following the inspection, we asked the provider to provide us with assurance that they would continue to make immediate and ongoing improvements. The provider responded positively and gave us assurance that it would continue to make the required improvements within a clear timeframe. This included the move towards implementing a recovery focussed model of care. We therefore made the decision not to take any further enforcement action at this time. However, we will continue to closely monitor the hospital and will not hesitate to act if improvements aren’t made in a timely manner.

The previous rating of ‘inadequate’ given following our inspection in January 2022 remains in place.

During the inspection we found:

  • The ward environments and equipment were cleaner and the overall state of the building had improved since our last inspection.
  • Risk assessments were mostly in place and reviewed, however, they sometimes lacked detail on how staff were managing risks.
  • At the previous inspection we found that staff did not always safely manage medicines. During this inspection, we found that whilst improvements had been made, some areas of concern remained.
  • The service did not comply with same sex guidance. There was no female lounge in the complex care unit despite female patients living there. Staff were not aware of all the risks and relevant risk assessments had not been carried out.
  • The provider had taken action to improve the number of suitably qualified staff. However, new staff were recently recruited, so more time was needed for them to have a meaningful impact on the quality of the services offered.
  • The quality of care plans had improved since our last inspection, however, this was work in progress and further improvement needed. For example, care plans included more information about patients’ physical health monitoring, but there was little evidence to demonstrate patient progress.
  • The service did not work to a recognised model of mental health rehabilitation.
  • Some people were living at the service for significant periods, however, some patients had moved on since our last visit.
  • We identified improvement around the governance arrangements in place. For example, new audits and meetings had been introduced. However, processes were not fully embedded and management oversight needed to be strengthen.

11 and 12 January 2022

During a routine inspection

Uplands Independent Hospital provides long stay and rehabilitation mental health service to people aged over 18.

Our rating of this location went down. We rated it as inadequate because:

The Care Quality Commission conducted an unannounced inspection of Uplands Independent Hospital on 11 -12 January 2022 following a number of concerns, being brought to our attention by staff at the hospital and from information that we had gathered during our routine monitoring of the hospital, about the safety and quality of care being provided.

Following the inspection, we sent the provider a Section 31 Letter of Intent (which requires the provider to give us assurance that it will make immediate improvements) as we found that significant improvement was needed to ensure patients received safe care. It requires the provider to give us assurance that it will make immediate improvements. Although the provider sent us an action plan describing the improvements it intended to make, we were not assured that urgent improvements would be made in a timely manner, so we served the provider with a Warning Notice.

The Warning Notice required the provider to make immediate improvements to ensure it met the legal requirements set out in the Health and Social Care Act:

In order to meet those requirements, the provider must:

Ensure robust risk assessments are completed that clearly identify how risks will be minimised; ensure care plans are person centred and clearly identify patient’s needs; ensure there is a focus on delivering recovery focused rehabilitation so that patients are supported to live independent lives and to prevent excessively long lengths of stay; ensure appropriate and timely physical health care for all patients, particularly for those with identified physical health problems. This includes ensuring medicines are administered as required, that there is a focus on monitoring patients who are on high doses of antipsychotic medicines and that medicines are stored and managed appropriately. The provider must ensure that environment and equipment is safe, clean and fit for purpose. In addition, the provider must ensure that there are enough, suitably qualified and competent staff on duty at all time and implement robust governance arrangements to ensure it is able to monitor incidents, the quality of care provided and make improvements in a timely manner.

As a result of our serious concerns about this service CQC’s Chief Inspector of Hospitals has placed this service in special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration. The service will be kept under review and, if needed, could be escalated to urgent enforcement action, including that described, at any time.

During the inspection we found:

Wards were not clean, and staff did not understand their responsibilities in respect of infection control. Cleaning schedules had not been completed and wards were not being cleaned regularly. On the high dependency unit (HDU) there was a strong unpleasant smell. Electrical items had not been tested for safety.

The hospital did not have suitably qualified, skilled and experienced staff to deliver person-centred and recovery focused care safely to patients. The culture within the service was not focused on providing rehabilitation and recovery focused care to the patients.

Risk assessments were not robust and did not identify all the risks for patients and had not been robustly reviewed. This meant staff did not have a full understanding of how they might protect patients from avoidable harm. Staff had failed to plan care according to the individual needs of the patients and some staff were unaware of the risks for patients. This meant that patients did not always receive the best support from staff to meet their individual care needs.

There was little evidence of a rehabilitation and recovery model of care being implemented at the hospital. Patients said there were a lack of suitable things to do and we did not see any activities to help patients learn new skills to help them move on and live more independently. The culture of the hospital was not one that moved patients towards discharge and the staff culture was more like that of a care home that would be classed as a person’s home for life.

The lack of focus on rehabilitation had led to significant lengths of stay for some patients. For example, the average length of stay for patients was about five years, which was significantly longer than you would expect in the setting. Senior managers confirmed that the service was not recovery-focused; they were unclear what a rehabilitation and recovery model should look like.

We reviewed four patient records on the complex care unit (CCU) and three on the high dependency unit (HDU). Physical health plans lacked detail so staff were unsure what they needed to do to monitor patient’s physical health care and meet their needs. For example, staff could not demonstrate that they had completed physical health checks such as lithium bloods or heart tracing electrocardiograms (ECGs) for patients who required these.

Staff had not considered the impact of the medicines on patients’ physical health and had not initiated high dose antipsychotic monitoring for patients. They were unsure of who was on a high dose of antipsychotics and as such were not taking steps to protect patients from avoidable harm.

Care plans were generally not recovery focused and did not detail how staff were to support patients with regaining the skills and confidence to live successfully in the community. For example, independent living skills such as cooking and budgeting. Care records lacked information about how the hospital was working with other agencies to support recovery and social inclusion in the community

None of the care plans that we reviewed had a discharge plan and there was no evidence of discussion with patients around their discharge. Some patients said that they were not included in planning their care. This meant patients were delayed from moving on from the hospital to an appropriate placement.

Although positive behaviour support (PBS) plans were in place for two patients (out of four records we reviewed) not all staff had received training in how to use the plans and staff were not following the plans

Staff did not always manage medicines effectively and safely. In the HDU clinic room there were several out of date medicines. Some medicine charts were not fully completed with reasons for missed doses of medicines.

Patients we spoke with said they did not always feel safe at the hospital and some staff were not responsive to their needs. Some patients said some staff did not always speak kindly to them and this impacted on their mental health. Some patients said staff did not always listen to their concerns and they did not always feel staff were acting in their best interests.

There senior leadership at the hospital did not have robust governance arrangements in place to monitor the safety of care and ensure any necessary improvements to protect patients from avoidable harm were made in a timely manner.

There was insufficient oversight to ensure incidents were appropriately reported and staff said there were problems with the current reporting process. This meant there was a risk some incidents were not being reported and investigated appropriately.

Staff acknowledged arrangements were not in place to regularly review care records, as such out of date care plans and risk assessments were not picked up. Senior managers at the hospital told us they were unclear who had written care plans and risk assessments and were not assured these were updated following decisions and discussions at multidisciplinary team meetings (MDT).

There were some blanket restrictions in place including staff keeping all patients smoking/vaping materials on HDU and limiting times when patients could smoke or vape.

Senior managers did not have a system to review staffing to ensure they had the right staff with the right skills to meet the needs of patients on all shifts.

However:

Many of the issues within the hospital had already been identified by the hospital director. The hospital director had developed a site improvement plan which detailed how they intended to make improvements at the hospital. The site improvement plan was an active document that helped the team focus on required improvements essential to patient care.

Staff spoke fondly about patients and said they had built good relationships with them over a period of time.

Patients had some access to psychological therapies and occupational therapy. The psychologist and occupational therapist had met with all patients on the ward and there was a psychology assistant who helped provide therapies identified by the psychologist including acceptance commitment therapy (ACT) and dialectical behavioural therapy (DBT).

The therapy team were keen to implement training for all staff about relevant issues including positive behaviour support (PBS) plans.

The service had access to a range of specialists to help meet the needs of the patients on the ward. A number of new staff were being recruited at the time of inspection.

Staff mitigated risks in the environment by use of mirrors and observations and were aware of ligature risk points.

Care records were kept securely. Staff had access to the care records and made daily notes about patients.

04/05 December 2018

During a routine inspection

We rated Uplands Independent Hospital as good because:

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national best practice guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service worked to a recognised model of mental health rehabilitation. It was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • The service did not maintain comprehensive ligature risk assessments.
  • The service did not ensure all staff were up to date with mandatory training, and up to date training records were not readily available.
  • The furniture and decor in the complex care ward appeared worn and in need of replacement. Although, work was underway to address this, and new furniture had been ordered.
  • The service did not proactively engage carers.
  • The service was not using standardised outcome measure for all patients.

10 and 11 Janaury 2017

During an inspection looking at part of the service

We rated Uplands Independent Hospital as requires improvement because:

  • In November 2015, we rated Uplands Independent Hospital as requires improvement. During this inspection (January 2017), progress had been made, which was sufficient to amend the ratings for Responsive and Well Led from requires improvement to good. Caring remained good. However, we were unable to re-rate Safe and Effective from requires improvement because of the issues around monitoring rapid tranquilisation and supervision and appraisals were breach of regulation that needed requirement notices.

  • Staff did not receive regular appraisals. Senior staff did not always provide debriefs following incidents. Nurses had not been following the rapid tranquilisation policy correctly.

  • Staff did not always update care plans correctly following a review. Staff had not updated the recovery star outcome measure regularly.

However:

  • The provider had an appropriate environmental risk assessment in place and plans to mitigate any identified risk. Staff reviewed risk assessments following any relevant incidents. Staff used handovers to update the team with changes to patient care including risk issues.

  • The provider identified how they could meet patients’ needs in recovery support plans. Patients were supported to write their own care plans and set their own goals. Staff met with patients monthly to review their goals and agree new ones.
  • The provider had governance systems in place that allowed them to monitor incidents and identify if there were any trends. The hospital manager shared information with staff about learning from incidents. There was a good oversight of the service, which the provider used to address quality issues.

24 and 25 November 2015 and 20 May 2016

During a routine inspection

We undertook a planned comprehensive inspection in November 2015 and found a number of serious concerns. We visited the provider again in May 2016 and found that the provider had made a number of significant changes and improvements. Both inspections are described within this report.

When we undertook the inspection in November 2015:

  • During our inspection visit in November 2015, we identified a number of serious concerns in relation to the governance and operation of the service. We took separate enforcement action by serving a warning notice in order to ensure the provider took immediate action to address the concerns identified.
  • The provider had not taken appropriate steps to address serious risks associated with the physical environment. For example, the hospital was in an old building with numerous blind spots. The hospital did not have any procedural management of ligature risks and individuals who presented specific risks did not have any individual ligature risk management care plans. The building ligature point assessment, (a ligature point is anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation), did not identify all ligature risks present within the building and assessed all risks from a general perspective such as architecture features, which included door hinges, architrave, fireplaces and window frames. There was no identified learning following a serious ligature incident in 2014, which resulted in a patient’s death. There was no hospital risk register. There was no senior oversight of risk; minutes from the provider’s governance meetings did not provide sufficient information about what those attending the meetings discussed or any quality or safety factors relating to Uplands Independent Hospital. The provider recognised that the current incident reporting system did not provide appropriate insight, although there was no clear plan to address this.
  • We identified serious concerns in relation to the provider’s systems for reporting incidents and learning from when things go wrong. There had been no training for the staff team at Uplands Independent Hospital on completing incident forms. We were concerned that inconsistent recording and reporting of incidents, lack of senior and organisational oversight, meant that the provider could not be assured that incident data was accurate and reflected the actual number or detail of incidents, or the current risks within the service. It also meant that potential trends or near misses might not be identified to learn from and prevent future incidents. The service’s incident reviews were not detailed enough to identify developing trends, or any learning that might improve services.
  • The recording of physical interventions, any form of physical contact and application of force to guide, restrict or prevent movement, did not meet the standards of the new Mental Health Act Code of Practice, as they did not identify the people involved, whether staff gave medication and, if so, by which route, and what the outcome was. Incident records reflected that seclusion, (the supervised confinement and isolation of a patient, away from other patients, in an area from which the patient is prevented from leaving), might have been used but not recognised by staff.
  • The hospital did not have access to a full range of professionals to ensure patients received appropriate care and treatment. Care plans were not personalised and ’pen pictures ‘used to allow new staff to gain a quick understanding of patients did not include all current risks. There was limited patient involvement in care planning and some patients had not been given copies of their care plan.
  • There were safeguarding threshold care plans in place (care plans used to stop unnecessary referrals to the local authority safeguarding team) but there was no monitoring in place to ensure they remained appropriate and effective. The hospital relied on risk assessments from previous placements for patients and did not consider the impact of a new environment on the patient.
  • Staff had not received training in the new Mental Health Act Code of Practice, and scrutiny of Mental Health Act paperwork was ineffective. There had been no consideration of mental capacity for informal patients.
  • The provider was starting to admit more patients from medium and low secure services. However, there had been no effective engagement with service commissioners, such as local Care Commissioning Groups, about the development of the service. There was no comprehensive plan for the proposed changes to the service or building alterations, there was a draft plan in place which lacked detail and was awaiting approval.

However, we also found:

  • The hospital was clean and maintained to a good state of repair. The hospital had accessible bathrooms. Female patients did not need to go through male areas to use bathrooms, and their bedrooms were behind a locked door.
  • We observed that staff treated patients with kindness and respect. Staff interacted respectfully with patients, sitting down to eat with them at meal times, and knocking on doors before entering bedrooms. Patients could visit the hospital before admission to familiarise themselves with the hospital, talk with patients and staff at meal times, and choose from any available bedrooms. There was a good range of activities and staff reviewed them with the patients monthly.
  • There were regular patient meetings and the hospital manager made themselves available to meet with the patients. Patients could personalise their bedroom.
  • The hospital manager was able to alter staffing levels to meet any changing clinical need.
  • Supervision records showed that staff received appropriate support from managers and that supervision happened regularly. Handover reports included information about risk and patient behaviour. Staff reported feeling supported by the hospital manager and were able to raise concerns. Some staff felt that they had been involved in some aspects of service development.

Following our visit in May 2016:

The provider produced an action plan to address our concerns and they then sent us an updated plan to identify the progress made. The lead commissioner, for the service, supported them in meeting the plan. We re-visited Uplands Independent Hospital on 20 May 2016. We were following up on the concerns identified in relation to the warning notice. We found that effective actions had been taken and we lifted the warning notice. We found that the team at Uplands had clearly worked very hard and made significant progress in a number of key areas of concern, most notably:

  • The ligature audit had been re-formatted and undertaken much more comprehensively with a clear risk rating, depending on a number of clearly identified factors. This in turn had been linked to the potential individual patient risks. All individual risk assessments and care records had been reviewed and updated. Risk assessments were well organised and detailed. There was a schedule of anti-ligature works available for us to review. The provider had taken a number of immediate actions to reduce the level of risk posed by the ward environment. For example, they had installed mirrors to increase the line of sight, and removed door openers and blocked in bannister spindles that might have been used as ligature anchor points. The management and staff team demonstrated a much better understanding of assessing and managing risks in the environment and relating this to individual and patient groups.
  • An improved governance structure has been put in place within the hospital and this had been linked to the new, wider provider governance meetings. Whilst it was still being established, with this new structure, there was potential for there to be much better senior oversight of a range of quality and safety issues. This made it more likely that any increased risks would be identified in a timely manner and the team should get the support they need from the provider to address them.
  • The provider had amended the incident reporting system. Investment in the incident reporting tool had enabled the staff team to enter a much more detailed report, this had the potential to record more accurately incidents allowing for clear review for trends and monitoring restraint activity.
  • The provider had updated Mental Health Act policies to take account of the revised code of Practice and made available the details of hospital managers. It had amended the incident reporting system to allow staff to record the appropriate detail in relation to restraints. The provider had updated the support plans for the management of violence and aggression for each patient. The hospital administrator had accessed specific training and an additional administrator had been employed to allow protected time to focus on the Mental Health Act administrator role.
  • Staff morale was good and staff reported that the additional investment and senior oversight was a positive for the development of the hospital, as well as day to day patient care and staff safety – whilst it was recognised there was still work to do, everyone felt more confident and supported to continue with the development of the service.

11, 12 August 2014

During an inspection in response to concerns

Uplands is an independent hospital for people with a mental health diagnosis, some of whom are detained under the Mental Health Act 1983. The service whilst offering treatment also aims to assist people with a mental health diagnosis to enhance their skills to be able to live in the community or at least more independently.

On the day we inspected there were 21 people living at Uplands. Some people were there informally and some were detained under the Mental Health Act 1983.

We visited the service in response to safeguarding concerns that had been raised.

We found that care plans and risk assessments had not been updated to reflect current needs of people using the service and the support they required.

Staff did not receive regular supervision in line with the provider CareTech’s policies.

Although the provider had assured CQC in 2013 that training would be available for staff working at Uplands to ensure they could meet the specific needs of people using the service, this had not happened.

The documents we saw did not show that the service was being monitored appropriately.

10 June 2013

During an inspection looking at part of the service

On the day we inspected there were 25 people living at Uplands some people were there informally and some were detained under the Mental Health Act 1983.

We observed staff being respectful, asking if people if they needed support and only assisting when asked.

We carried out an inspection in February 2013 when we identified concerns with consent, care and welfare and medicine records. We made compliance actions asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and they sent us an update on their actions in May 2013.

We inspected on 6 June 2013 to review the progress the provider had made. We found that the provider had taken steps to improve consent, care planning and medicine records. Individualised care plans detailed the support and care each person required. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with six staff and the registered manager.

There were effective arrangements in place to ensure the home was clean and free from infection. The quality of the service provided was monitored by an effective quality assurance processes.

4 February 2013

During a routine inspection

Uplands is an independent hospital for people with a mental health diagnosis, some of whom are detained under the Mental Health Act 1983. The service whilst offering treatment also aims to assist people with a mental health diagnosis to enhance their skills to be able to live in the community or at least more independently.

On the day of our visit there were 27 people living at the service we spoke with seven of them and they described their experiences of care. One person described their experience as “It’s generally okay, not the place for me. Staff are caring but I can’t do anything without them. I want to go out but need staff with me so I don’t always bother”. Another commented, “Staff care, I get on well with most of them. They try and help. I do lots of things like watching TV or DVD’s and I go out sometimes”.

We spoke with six staff and the registered manager. Staff told us about working at Uplands and the support they receive from senior managers. “The management are really approachable, easy to talk to and will point them in the right direction”. One person told us about their induction and said, “It was the most comprehensive induction I have had”. The staff we met also told us about the training they had attended and that they were able to speak openly with senior staff and the manager about any concerns.

We found areas of concern with consent to treatment, care plans and medicine records. All of these areas were discussed with the manager.

2 August 2011

During an inspection in response to concerns

Most people told us that they were happy at Uplands; some people do not have a choice at the moment but to be there as they are detained under the Mental Health Act.

They liked the interaction with the staff and were very fond of some of them. They said they are able to give their opinion, for example about the food and they feel respected and heard. They are able to have visitors at any time. Observation of staff and patient interaction seemed to be good with staff offering choice and time for people to express in their own way what they wanted.

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.