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Jigsaw Independent Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 31 March 2017

We rated Jigsaw Independent Hospital as requires improvement because:

We inspected Jigsaw Independent Hospital to see whether improvements had been made following a comprehensive inspection in March 2016. At that inspection, we had issued requirement notices for breaches of regulations relating to person centred care, good governance, staffing and duty of candour.

A warning notice had been served for a breach of regulation 12 of the Health and Social Care Act (2014) and an inspection visit in August 2016 confirmed that issues had been addressed and this warning notice was met.

At this current inspection, we found improvements and changes had been made throughout the hospital.

There had been a review of blanket restrictions throughout the hospital and many of the restrictions that had been in place had been altered. There was a collaborative multidisciplinary approach to delivering care. There had been a review of patient pathways throughout the service and evidence of discharge planning was apparent from talking to patients and reviewing records. The hospital now had a clear admission process.

In terms of good governance, we found records were well maintained and comprehensive. Physical health information was included in health passports. A new governance structure had been established and this ensured information was communicated up to board level and back down to ward level. A duty of candour policy had been developed and staff were aware of this. We found that although overall governance had improved, there were still areas which lacked sufficient oversight, for example, training levels, policies, ligature audits and out of date clinical stocks. There were also still issues with the Mental Health Act policies despite these being reviewed.

Inspection areas

Safe

Requires improvement

Updated 31 March 2017

We rated safe as requires improvement because:

  • Although ligature audits had been completed for each ward area and reviewed at six-month intervals, they were not up to date with maintenance that had been undertaken and did not include all ward areas, However, staff knew where the risks were on the ward and had acted to reduce them.
  • Mandatory training figures were improved since the last inspection, however less than 50% of staff were up to date with moving and handling training. Although not all qualified staff were up to date with immediate life support training, staff had been booked to attend training in the two weeks following the inspection. Training rates had also been added to the risk register in December.
  • Medicines management practice was good, but we found out of date urine testing kits and alcohol swabs on Cavendish ward.

However:

  • Ward areas, including clinic rooms and kitchens, were clean and tidy.
  • Staff checked resuscitation equipment was in good order on a daily basis.
  • Staffing levels were maintained and additional staff could be booked if needed.
  • Use of restraint was low and staff were knowledgeable about alternative strategies for managing agitation or aggression.
  • Staff completed risk assessments which were thorough and regularly updated.
  • Blanket restrictions had been reviewed and removed, including bans on mobile phones and previously limited kitchen access.
  • Staff knowledge of safeguarding was good and safeguarding notifications were made when needed.
  • Medicines management practice was generally good, with no issues found in relation to medication stock and pharmacy supply, controlled drugs practice and consent to treatment.

Effective

Good

Updated 31 March 2017

We rated effective as good because:

  • Nurses completed comprehensive, up to date care plans including physical health plans.
  • Health action passports were stored with medicines cards and were updated following GP or hospital visits.
  • On Oriel ward, staff had completed one page profile documents which were detailed and specific to the individual patient. There was also use of “all about me” booklets.
  • There were effective multidisciplinary teams including occupational therapy and psychology staff.
  • Staff were receiving regular supervision.
  • Staff had good understanding of the Mental Health Act and its application.
  • Staff had good understanding of the Mental Capacity Act and deprivation of liberty safeguards.
  • Staff had received training in equality and diversity and transgender awareness.

However:

  • On Oriel ward, only one record contained care plans in an accessible format. Care plans on Oriel ward also included using visual prompts for certain patients, but we did not observe this happening in practice.
  • Whilst appraisal rates had improved, 64% of staff had a current appraisal and appraisals had been booked in for all staff.
  • Not all Mental Health Act policies reflected the code of practice.
  • There were no accessible Mental Health Act leaflets available on Oriel ward.

Caring

Good

Updated 31 March 2017

We rated caring as good because:

  • We saw positive and respectful interactions between staff and patients during this inspection.
  • We received positive feedback about the hospital and staff from nearly all patients interviewed.
  • Most patients reported that they found the managers approachable and knew who they were and how to contact them.
  • Most patients interviewed were positive about their involvement in care planning.
  • Patients told us they had regular individual sessions and knew who their keyworker was.
  • Community meetings took place on all wards on a daily basis, these were either in the mornings or evenings, depending on patient preference.
  • We spoke to carers who all gave positive feedback about the hospital.
  • Carers shared with us experiences where they felt staff had provided individualised, well planned care to deal with transitions and stressful events.
  • Carers told us they had good communication from the hospital.
  • All patients were positive about the advocacy service and knew how to contact the advocate.
  • A patient survey had been completed in November/December 2016.
  • There was a patient forum which met on a monthly basis with the hospital managers.

Responsive

Good

Updated 31 March 2017

We rated responsive as good because:

  • Managers had devised an admission standard operating procedure.
  • We saw transitional planning in place for a patient who was visiting on overnight leave leading up to admission.
  • The service had reviewed all current patients recently with the commissioning manager regarding discharge pathways and plans.
  • Discharge pathways were discussed as part of care programme approach review meetings and with commissioners and care managers.
  • The transitional arrangements for patients admitted to Oriel ward were excellent.
  • There were plans to refurbish rooms previously designated as de-escalation rooms.
  • Patients on all wards were able to access their bedrooms throughout the day.
  • On all wards, patients were able to have their own mobile phones, with use of these limited only if clinically indicated.
  • Some patients had key fobs allowing them to access the gardens when they wished, patients without this level of leave were able to access the garden at regular intervals throughout the day.
  • Patients on all wards were able to access kitchen areas to make drinks and snacks.
  • There was well staffed occupational therapy and psychology provision.
  • We saw information displayed within wards about the advocacy service and how to give feedback and make complaints.
  • Suggestion boxes were in place on wards and we were told these were emptied regularly and any suggestions reviewed by managers.

However:

  • There was a lack of pictures or information displayed on Oriel ward. There was a lack of easy read information on display, and leaflets/written information for patients, although this was in place in other ward areas.

Well-led

Requires improvement

Updated 31 March 2017

We rated well-led as requires improvement because:

  • The monitoring system to ensure all staff had the necessary training and supervision was not always effective. Supervision and appraisal figures were not up to date
  • Although, the service had identified that training for immediate life support training had fallen below 75% following staff leaving and training was booked, this was not the case for moving and handling training.
  • Additional training undertaken by staff was not being recorded so it was not possible to monitor when this needed updating.
  • There was a lack of sufficient oversight of the Mental Health Act in terms of policies.
  • There was no system in place for checking clinical sundries stocks.
  • Ligature audits were not up to date despite recent reviews.
  • A new governance structure was in place but this required further improvement in terms of the information being fed in and overall monitoring as above.

However:

  • Staff knew who the managers in the organisation were and told us that managers were approachable and regularly visited the wards.
  • A team meeting at 9am each morning had been introduced to ensure all staff were aware of any incidents or relevant information for that day.
  • Managers were able to analyse data using an incident management system.
  • Personnel files were well managed and contained all necessary information.
  • Staff had completed a staff survey and gave positive responses regarding effective leadership and management, induction, vision and values and training.
  • There were plans for rolling out freedom to speak out sessions and a staff welfare policy was being devised with staff.
  • Staff interviewed felt morale was generally good and described good working relationships with their teams.
  • Staff told us they could raise concerns appropriately.
Checks on specific services

Long stay/rehabilitation mental health wards for working age adults

Requires improvement

Updated 31 March 2017