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Inspection Summary


Overall summary & rating

Good

Updated 9 February 2018

We rated Chadwick Lodge as good because:

Patients had excellent access to psychological therapies. The psychology team operated a comprehensive, patient focused, individualised service (for example, by adapting therapy sessions to suit the needs of patients with autistic spectrum disorder or a learning disability). Their dialectical behaviour therapy program had been specially adapted for use in forensic services, and it linked with the cognitive behavioural therapy and trauma work. Psychology staff offered individual and group work to address offending behaviours and substance misuse. They also provided specialist treatment programs for male sex offenders and females with a history of fire setting. Members of the psychology team recently organised a national conference on the therapeutic treatment of sex offenders.

Staff received necessary training, an appraisal and regular supervision, and medical staff completed revalidation. Most staff had a high level of morale and job satisfaction. They felt supported by their peers and by managers and felt able to raise concerns without fear of victimisation. In general, staff were highly positive about the organisational transition from the Priory Group to Elysium Healthcare.

The hospital has been an accredited member of the Royal College of Psychiatry quality network for forensic mental health services, for both medium and low secure services, since 2011.

Occupational therapy was available to patients on all wards. Therapists operated a model which focused on a holistic, person centred and recovery based approach. Staff helped patients to build and maintain independence by encouraging them to participate in activities of daily living. Patients had the opportunity to undertake voluntary work, either within the hospital or in the local community, appropriate to their ability and individually assessed level of risk. Patients had access to a hospital gym and to outside space, including a courtyard area with an enclosed sports pitch.

Staff provided patients with extensive support to prepare them for admission to the hospital; moving to a different ward; or, being discharged from the hospital. Care plans we looked at were individualised, holistic, recovery focused and up to date. Occupational therapy staff were fully trained to use the model of human occupation screening tool, to help inform patient care plans. Patients had an initial physical health assessment and good access to ongoing physical healthcare.

Patients were extensively involved in their own care and the running of the service. Staff sought patient input when devising risk assessments and care plans, and patients attended meetings about their own care. Some patients had helped to devise a handbook for newly admitted peers and a DVD to inform and promote the psychological therapy program to students and other patients. Patients attended ward daily meetings, community meetings and regular forums. They were involved in the recruitment of all staff at every level and had the ability to nominate elements of the service for upcoming audits.

Staff treated patients in a caring, respectful and responsive manner. Staff displayed a high level of understanding of the individual needs and abilities of patients. Staff supported patients to maintain personal relationships during their time within the hospital. Patients had access to general and statutory advocacy services, and interpreters were available to patients as needed.

Patients had a comprehensive risk assessment on admission, which was regularly reviewed and updated. Staff applied blanket restrictions only when justified and minimised their use where possible. Staff used good policies and procedures for observing and searching patients and the ward environment, in order to minimise identified risks. All wards had a detailed ligature risk assessment in place. Most wards had anti-ligature fittings throughout.

Staff reported incidents appropriately and investigated them thoroughly. Staff met to discuss learning from incidents and received support following serious incidents. Staff used learning from incidents to inform future practice and they shared feedback on incidents with patients.

Escorted leave and ward activities were rarely cancelled due to staff shortages. Staffing levels were managed to meet changing demands on each ward. The hospital had a low number of vacancies for substantive staff. All bank workers were required to complete the same induction program and ongoing training as substantive staff. Where possible, managers attempted to deploy bank workers to wards they were familiar with.

However:

The closed-circuit television cameras in the seclusion suite on Berridale ward did not have a protective pane of Perspex, to prevent them potentially being removed by a patient. If a patient were to remove one or more of the cameras, staff would not be able to maintain an unbroken view of the patient.

Social workers had a supervision rate below the hospital’s stated target of 85%, with a rate of 76%.

Some patients told us they sometimes found the diction of some members of staff difficult to understand and this could impact on communication between staff and patients. They told us that this was more evident with members of bank staff who were not familiar with those patients.

Some patients we spoke with were unhappy with the quality of food provided.

Some patients we spoke with told us they would like there to be more activities on offer.

Some nursing assistants we spoke with did not feel engaged with senior managers and the process of change within the hospital. They reported feeling undervalued by managers. Staff commented negatively about the introduction of a new arrangement for taking breaks.

The rehabilitation ward had a blind spot in the garden area which had not been risk assessed, the laundry room was untidy and dirty and the kitchen fridge needed de-frosting

Inspection areas

Safe

Good

Updated 9 February 2018

We rated safe as good because:

The wards had good lines of sight and staff mitigated risks from any blind spots by use of mirrors or staff observation. All staff carried alarms and there were call points in each room.

All wards had a detailed ligature risk assessment in place. Most wards had anti-ligature fittings throughout. Any remaining ligature risks were appropriate to the patient group on the ward and further mitigated by increased levels of staff observation. Emergency equipment was available and regularly checked.

The hospital had three seclusion facilities that were all modern, purpose-built and suitably appointed. Staff followed hospital policies for the use of seclusion and long-term segregation and only used either of those interventions as a last resort. Staff recorded and reviewed episodes of seclusion and long-term segregation appropriately. There was a recently established protocol for transferring patients to any of the seclusion suites.

Escorted leave and ward activities were rarely cancelled due to staff shortages. Staffing levels were managed and changes made to meet the needs of each ward. The hospital had a low number of vacancies for substantive staff. All bank workers were required to complete the same induction program and ongoing training as substantive staff. Where possible, managers attempted to deploy bank workers to wards they were familiar with.

Staff received mandatory training in a combination of face-to-face sessions and elearning modules. The compliance percentage for each course was over 75%.

Staff used an electronic system to report incidents. Incidents records were appropriate and thorough. Staff met to discuss incidents, including serious incidents at other Elysium hospitals. They received appropriate support following serious incidents. Staff used learning from incidents to inform future practice. Staff shared feedback on incidents with patients.

Patients had a comprehensive risk assessment on admission and they were regularly reviewed and updated following any significant occurrence. Staff applied blanket restrictions only when justified and minimised their use where possible. Staff used good policies and procedures for observing and searching patients and the ward environment, in order to minimise identified risks.

Senior managers were flexible and responded well if the needs of patients’ increased and additional staff were required.

Staff received training in the use of de-escalation techniques and only used physical restraint after de-escalation had failed.

The hospital contracted the services of an external pharmacist who conducted regular audits of medicine storage and administration. The pharmacist participated in clinical governance meetings, met with the responsible clinician on a regular basis and delivered medicines management training to staff.

However:

The closed-circuit television cameras in the seclusion suite on Berridale ward did not have a protective pane of Perspex over their front, unlike the cameras within the central seclusion suite. There was therefore a possibility that a patient could pull the unprotected cameras from their mountings on the walls of the Berridale suite, thereby removing the ability for staff to maintain a constant view of the patient.

The furnishings and decor in the secure wards on the Eaglestone View site were in need of an update. The hospital had an agreed program of capital expenditure, which included the refurbishment of those wards.

There was a blind spot in the garden area of Hope House which had not been risk assessed. The laundry room was untidy and dirty and the kitchen fridge needed de-frosting.

Effective

Good

Updated 9 February 2018

We rated effective as good because:

Patients in the forensic secure service had excellent access to psychological therapies. The psychology team operated a comprehensive, patient focused, individualised service. The dialectical behaviour therapy program had been specially adapted for use in forensic services, and it linked with the cognitive behavioural therapy and trauma work. Psychology staff offered individual and group work to address offending behaviours and substance misuse. They also operated specialist treatment programs for male sex offenders and females with a history of fire setting.

Patients in the rehabilitation ward, Hope House, had access to a variety of psychological therapies which were all based on the dialectical behavioural therapy model as described as best practice in the National Institute for Health and Care Excellence guidance. This therapy was delivered either on a one to one basis or in a group setting, as part of the treatment programme and psychologists, occupational therapists, social workers and the nursing team had all been trained in dialectical behavioural therapy. Skilled staff delivered care and treatment. Throughout Hope House the multidisciplinary team was consistently and pro-actively involved in patient care.

Staff completed a thorough multidisciplinary assessment before admitting each patient. Care plans we looked at were individualised, holistic, recovery focused and up to date. The prescribing of medicines followed National Institute for Health and Care Excellence guidance.

The staff team for each ward came from a variety of professional backgrounds, including medical, nursing, psychology, social work and occupational therapy. A contracted pharmacist spent one and a half days at the hospital each week. Staff had the appropriate level of experience and qualifications, and had access to a wide range of relevant training courses.

Patients had an initial physical health assessment. The ongoing monitoring of physical health was appropriate and patients had good access to physical healthcare. Staff supported patients to stop smoking, aided by nicotine replacement therapies.

Staff received an appraisal and regular supervision. Medical staff completed revalidation. All staff participated in reflective practice sessions, where they could discuss instances of good practice and areas for development.

There were strong working relationships within each ward team and between different teams throughout the hospital. Staff attended a range of regular meetings and managers participated in a monthly peer audit system. Staff worked proactively to foster strong working relationships with external agencies.

Mental Health Act records were in good order and staff received appropriate support from Mental Health Act administrators. Most staff had completed up-to-date training in the Mental Health Act. Patients could access specialist independent mental health advocacy services as required.

Staff received up-to-date training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Patients could access specialist independent mental capacity advocacy services as required.

There was evidence of best practice and that all staff had a good understanding of the Mental Health Act 1983 (MHA), the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and the associated Codes of Practice.

However:

Social workers had a supervision rate below the hospital’s stated target of 85%, with a rate of 76%.

Patients did not have access to dental appointments within the confines of the hospital, which meant that patients could miss appointments if they had not been granted leave.

Caring

Good

Updated 9 February 2018

We rated caring as good because:

Staff treated patients in a caring, respectful and responsive manner. Staff displayed a high level of understanding of the individual needs and abilities of patients.

Staff supported patients to maintain personal relationships during their time within the hospital.

Staff had implemented initiatives to involve patients in their care and treatment. Patients had extensive involvement in the operation of the service. Patients had helped to devise a comprehensive handbook, given to newly admitted patients. Patients attended ward daily meetings, community meetings and regular forums. Patients were involved in the recruitment of all staff at every level. Patients had the ability to nominate elements of the service for upcoming audits. Patients made a DVDs about the therapies provided at the hospital.

Patients were involved in their own care. Staff sought patient input for risk assessments and care plans. Staff actively encouraged patients to attend multidisciplinary meetings and care program approach (CPA) meetings and staff encouraged them to participate in discussions about their care.

Staff helped patients to build and maintain independence by encouraging them to participate in activities of daily living. Some patients had a weekly food budget, went shopping for their own food and prepared all their own meals.

However:

Some patients told us they sometimes found the diction of some members of staff difficult to understand and this could impact on communication between staff and patients. They told us that this was more evident with members of bank staff who were not familiar with those patients.

Responsive

Good

Updated 9 February 2018

We rated responsive as good because:

Patients had a clear care pathway to move between medium secure wards and less restrictive low secure wards. Staff supported patients when they were moving to another ward or preparing for discharge from the hospital. Staff worked with other agencies to ensure that appropriate aftercare services were in place for discharged patients.

Information about the complaints process was displayed on ward notice boards and in the handbook issued to new patients. Staff discussed themes from complaints received during clinical governance meetings.

Occupational therapy was available to patients on all wards, with a variety of therapy sessions offered. The occupational therapists operated a model that focussed on a holistic, person centred and recovery based approach. There was a varied and recovery orientated programme of therapeutic activities available.

Patients had the opportunity to undertake voluntary work, either within the hospital or in the local community, appropriate to their ability and individually assessed level of risk.

The general environment within the hospital was suitable for people with restricted physical mobility and patients with specific physical needs had necessary adjustments made to their bedroom and en suite toilet and shower facilities.

Psychologists adapted therapy sessions to suit the needs of patients with autistic spectrum disorder or a learning disability.

However:

Some patients we spoke with were unhappy with the quality of food provided, however catering staff had begun to meet individually with patients to discuss their dietary requirements and preferences

Some patients we spoke with told us they would like there to be more activities on offer.

There was no facility within the hospital to enable patients with restricted mobility to have a bath.

Patients did not always receive timely feedback on complaints they had made.

The communal areas within Avon, Berridale and Calder wards were noticeably cold on the first day of our inspection visit. Some patients wore outer garments within those areas of the wards. We highlighted this issue to the hospital director at the end of that day.

Well-led

Good

Updated 9 February 2018

We rated well-led as good because:

The hospital has been an accredited member of the Royal College of Psychiatry quality network for forensic mental health services, for both medium and low secure services, since 2011. Staff were working to obtain national accreditation for their dialectical behaviour therapy (DBT) program.

Members of the psychology team recently organised a national conference on the therapeutic treatment of sex offenders. The hospital is planning to host a conference for forensic services during 2018.

Most staff had received an appraisal, received regular supervision and had completed mandatory training.

The hospital had a comprehensive governance framework, which incorporated clinical governance meetings, daily planning meetings, staff and community meetings and a range of meetings, each of which focussed on a particular element of service delivery. Staff had access to an electronic dashboard that clearly displayed important information for the running of each ward.

A member of the senior leadership team visited each ward on a monthly basis, to assess the experience of patients and staff. Clinical ward managers completed a monthly peer audit of a random selection of patient care records from a different ward.

Most staff had a high level of morale and job satisfaction. They felt supported by managers and able to raise concerns without fear of victimisation. Most staff were highly positive about the organisational transition from the Priory Group to Elysium Healthcare. Staff met regularly to discuss current issues and recent events. Each ward had a monthly reflective practice session and staff could give feedback in regular staff forum meetings.

However:

Some nursing assistants we spoke with thought that senior managers had an insufficient level of presence on the wards.

Some nursing assistants we spoke with felt less engaged with the management structure and the process of change within the hospital. They reported feeling undervalued by managers.

The recent introduction of a one hour and 47-minute break had had a detrimental effect on the morale of some staff.

Checks on specific services

Forensic inpatient/secure wards

Good

Updated 9 February 2018

Long stay/rehabilitation mental health wards for working age adults

Good

Updated 9 February 2018