Archived: The Spinney

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We conducted this unannounced focused inspection to review two requirement notices given at our last comprehensive inspection in October 2015. We published our inspection report in February 2016. The requirement notices related to the safe key question which we rated as requiring improvement due to breaches of regulation 9 - person-centred care and regulation 12 - safe care. Following the inspection in October 2015, the provider submitted action plans telling us how they would make improvements. This also covered areas where we had made recommendations.

We inspected The Spinney on 10 and 15 August 2016 to check whether these improvements had been made. We visited all the forensic wards and the psychiatric intensive care unit. We found areas of good practice:

• Managers in the hospital had taken sufficient action to address the requirement notices we issued following the inspection in October 2015.
• Staff completed risk assessments of patients at admission and on an ongoing basis.
• There were new protocols to guide staff on de-escalating patients’ disturbed behaviour in the observation lounges.
• Staff and managers monitored the use of high dose antipsychotic medication.
• There were improved medicine management arrangements with reviews of medicines prescribed 'as required'.
• Wards were clean, well maintained and ligature risks were managed.
• Staffing levels were safe with low levels of sickness and agency use.
• Staff received appropriate mandatory training.
• There were low levels of restraint and where restraint had been used it was monitored by managers.
• There were appropriate lessons learnt following incidents.

As managers at The Spinney had made the improvements within six months from the date of publication of the last report, we re-rated the safe key question from requires improvement to good. Using our aggregation principles, this also led to an overall rating of outstanding for The Spinney as the caring and responsive key questions were previously rated as outstanding and all other key questions rated as good.

However, we also found some areas for improvement:

• Patients on Rivington and Lever wards were subject to restrictions on accessing their bedrooms due to the ward layout. Managers were addressing these restrictions.
• There were small number of delays in doctors attending episodes of seclusion out of hours on Hulton ward and the long-term segregation policy required amendment about our role.
• A small number of patients on high-dose antipsychotics regularly refused health checks and there was limited recording of the benefits and risks of continuing with the regime.
• On some wards, the written ward ligature risk assessment was not readily available to all staff.

We rated The Spinney as good because:

• wards were clean and generally well maintained, with systems to allow effective observation of patients
• staff checked emergency equipment regularly to ensure it worked properly
• staff completed and reviewed risk management plans
• staffing levels were safe and staff received appropriate mandatory training
• staff completed care plans which were up to date and reviewed regularly
• patients had good access to psychological therapies
• staff had good opportunities for training and development
• patient involvement in their own care was excellent
• patients were highly involved in shaping the service – for example, interviewing staff
• patients could engage in a wide range of meaningful activities
• staff and patients had established excellent community links and vocational placements
• patients were engaged in meaningful employment and gaining real work skills
• carers provision was excellent and innovative
• patients and staff knew the complaints procedure and there was effective ward-based recording and resolution
• staff understood and demonstrated the values of the organisation
• staff felt supported and valued
• there was a clear governance structure with effective management across the service
• ward and senior managers provided effective leadership
• staff were committed to improving quality.

However:

• staff did not always complete a risk assessment of patients at admission
• patients were subject to some blanket restrictions on their freedom, which might be unnecessarily restrictive
• staff did not always monitor the use of high dose antipsychotic medication in required cases
• physical health documentation, including records of examination, was difficult to find in the records
• managers were not supervising the work performance of nursing staff as defined in the hospital policy and were not ensuring that staff meetings took place regularly
• patients complained about waiting times for a specific psychological programme
• we were concerned about the use of observations lounges in some wards and documentation of this
• staff recorded some instances of seclusion wrongly as long-term segregation
• staff’s knowledge of the Mental Capacity Act was inconsistent across different wards
• staff identified difficulties in procedures around maintenance requests.