Archived: Connolly House

We rated Connolly House as good because:

• The provider had an up to date ligature risk assessments and mitigated for any risks by patient observation levels where appropriate.
• Although some bedroom toilets smelt of urine, the cleanliness of the environment was maintained, cleaning schedules were in date and environmental risk assessments were completed. Staff had highlighted uneven floors causing trip hazards with floor marking signs to alert people to this risk. The provider plans to further address these risks in future renovation works.
• Staff completed individualised risk assessments of manual handling needs to manage patients at risk of falls. Staff used motion sensors in bedrooms to manage patients at risk of falls during the night.
• The provider had good medicines management practices.
• Incidents were reviewed, investigated and lessons learnt were shared with staff.
• Staff completed patient individualised and holistic care plans and monitored patients’ physical health regularly.
• Staff received an induction, completed dementia specific training and support staff completed the care certificate training. Staff had yearly appraisals, regular supervisions and staff meetings.
• Staff completed decision specific capacity assessments and best interest decisions were made with family involvement. Deprivation of Liberty Safeguard applications were granted for thirteen patients with review dates. Doctors prescribed covert medication, when required, with clear guidance from pharmacy for staff when administering.
• Relatives made positive comments about the care and treatment provided by staff for patients and we observed caring and kind interactions by staff towards patients. Relatives were involved in compiling ‘My Charts’ detailing information about patients, and were involved in the care planning processes and best interest decisions.
• The provider responded to and investigated complaints. Relatives were provided with responses to complaints and staff were provided with lessons learnt from these.
• Staff survey results generally showed positive results. Staff felt able to raise concerns and spoke positively about working within the team and for the provider.

However:

• Staff mandatory training fell below 75% compliance for some subjects. Three staff members had no training in physical restraint, which meant the safety of staff and patients was not maintained.
• Staff did not always conduct or document patients’ prescribed care interventions or observations.
• The provider did not ensure plans for staffing during the evenings and overnight were clearly recorded on the duty rota.
• The provider had dangerous electrical wiring in the lounge, which we highlighted. The provider removed this whilst we were on site.
• The provider had syringes unwrapped in a plastic box with no expiry date in the clinic room. We raised this with the provider who told us these were not in use and removed these whilst we were on site.

• The environment contained multiple ligature points. A ligature point is anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation. Staff could not explain what a ligature risk was and the provider’s ligature risk assessment was out of date.
• Female patients did not have an identified female lounge limiting their access to female only areas. The provider had no available bathing facilities for patients within the hospital. The bath was broken and there was one shower in the male corridor for all patients to use. Female patients had to access the male corridor to use the shower room. This did not meet the Department of Health’s guidance on eliminating mixed sex accommodation or the Mental Health Act Code of Practice requirements. We reviewed the providers 'bath and shower book’ which is a record of when patients had bathed. We found that over nineteen days patients did not receive regular baths or showers.
• The hospital décor was poor; the environment was dirty in places and poorly designed to meet the needs of the patient group. The floors were uneven causing a trip hazard. There were blind spots where staff could not easily see all parts of the ward. Despite the provider completing individual patient risk assessments, it was not clear how staff managed the risk of falls for patients, given the environment and patient group.
• The provider did not check physical health equipment regularly. We could not tell when the blood monitoring machine was last calibrated (a test to ensure readings are accurate). We found expired needles and syringes, no recording of fridge temperature on five occasions and no recording of drug disposal.
• The provider had not ensured staff had appropriate information for safe administration of covert medication to patients.
• The provider did not have an evacuation chair for immobile patients to exit the building in the event of a fire. We addressed this urgently with senior managers who replaced the chair immediately. Patients did not have personal evacuation care plans so staff knew how to support patients to exit the building.
• Staffing levels at night were not sufficient to managing patients at risk of falls. Staff told us that two staff would work at night and manage patient observations for those who woke, with a risk of falls. Staff could not predict when patients would sleep or wake throughout the night, and therefore, we were unclear how staff safely managed patients at the hospital during the night.
• Staff were observed to use unapproved manual handling techniques on two patients.
• We observed restrictive practice for one patient with manual handling needs who was lying on a bean bag. The patient was unable to move independently and required assistance from staff to do so. There was no care plan for this patient on the use of a bean bag.
• We reviewed incident form outcomes and found observation levels were not always increased for patients following falls.
• One member of staff told us the male and female toilets were too small to attend to patients’ personal care needs safely. Staff occasionally attended to the personal care needs of patients in the corridor outside the toilets. This did not promote the privacy or dignity of patients.
• We reviewed eight care records and found limited involvement with family members in care planning.
• The provider did not ensure regular supervisions or staff meetings took place for staff.
• The provider was unable to provide us with a copy of their risk register.
• The provider did not demonstrate they were reviewing and learning from incidents.
• The provider had three outdated policies and 22 staff had not signed signature lists attached to 49 policies to say that they had read them.
• The hospital did not produce accurate and contemporaneous records of incidents.

However:

• Staff had received and were up to date with all mandatory training. Compliance rates were between 90% and 100%.
• Easy read signage was available for patients to be able to identify rooms and facilities.
• The provider was reviewing risk assessment documentation and implementing new assessment tools.
• We reviewed multi-disciplinary records and found family involvement in some best interest decisions for patients.
• We saw advocacy information posted on notice boards in the lounge and in folders in patient bedrooms including complaints information, complaining to the care quality commission, social services and the health ombudsman.
• We saw updated patient ‘my charts’ completed with family involvement on patients’ interests, preferences, history, likes and dislikes.
• The provider recently appointed the clinical manager who was working with the deputy director and director to improve the service.