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Jigsaw Independent Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 March 2018

At the last inspection the service was rated as requires improvement, with ratings of good for effective, caring and responsive domains.

This inspection focused on the safe and well led domains, which were both rated as requires improvement previously.

Improvements had been made following the previous inspection. At the last inspection, there were issues with governance in terms of training levels, policies, ligature audits and out of date clinical stocks. At this inspection, we found most of these issues had been addressed with training monitored, policies updated, a new system for completing ligature audits in place and no medicines issues. Ligature risk assessments were improved although for one ward they did not capture all potential risks. Whilst there were records for regular supervision with staff and improved oversight, we were concerned about the use of a pre-filled template which staff signed.

At this inspection, we had concerns with oversight in terms of staffing, particularly that there had been occasions in the past six months were one registered nurse had been in charge of two wards and monitoring, in terms of assessing the quality of documentation, for example, moving and handling assessments.

We found issues with moving and handling assessments, falls risk assessments and care planning in relation to moving and handling and falls prevention.

Inspection areas

Safe

Requires improvement

Updated 22 March 2018

We rated safe as requires improvement because:

  • Two bedrooms on Linden ward required repair although maintenance staff were aware of these and had plans to address issues.
  • There were restrictions in place including the laundry and kitchen being locked and individual bathrooms and wardrobes locked on Cavendish ward.
  • There had been 16 occasions in the past six months were one registered nurse had been in charge of two wards.
  • In two patient’s files, we found the risk assessments did not include all incidents which had occurred.
  • Individual manual handling assessment forms lacked sufficient detail to enable staff to support patients safely.
  • There were no risk assessments or care plans for two patients with bed rails.
  • There was no use of specific falls risk assessments and for those patients identified as at risk of falls or having a history of falls, there was no clear plan for how to assist if they fell.
  • Resuscitation equipment was stored in a locked cupboard which limited access in an emergency.

However:

  • Ward areas were clean and well maintained, including clinic rooms.
  • Medicines management was good including storage, administration and checks.
  • The service had a full time and part time psychiatrist providing medical cover.
  • Staff undertook physical health monitoring and physical health care plans were up to date and clear.
  • Staff knew how to report incidents and we saw completed incident forms in patient records.

The provider had started to complete individual analyses of incidents for patients to assist in care planning.

Effective

Good

Updated 22 March 2018

Following our inspection in January 2017, we rated the service as good for effective. Since that inspection we have received no information that would cause us to re-inspect these key questions or change the ratings for effective.

However:

  • We did note issues with capacity assessments which are detailed in the main report.
  • We noted issues with supervision documents which are detailed in the main report.

Caring

Good

Updated 22 March 2018

We rated caring as good at our last inspection. We did not inspect this domain. 

Responsive

Good

Updated 22 March 2018

We rated responsive as good at our last inspection. We did not inspect this domain.

Well-led

Requires improvement

Updated 22 March 2018

We rated well-led as requires improvement because

  • There was not sufficient oversight of staffing and the quality of documentation, for example, moving and handling assessments.
  • Restrictive practices had not been reviewed.
  • Supervision records contained pre-populated forms rather than a record of supervision.
  • Staff meetings were not taking place as planned.

However:

  • Governance structures had improved with local meetings feeding into a corporate governance committee.
  • We saw that the service had identified areas for improvement within the service and worked to improve these, for example, the length of stay and discharge planning.
Checks on specific services

Long stay/rehabilitation mental health wards for working age adults

Requires improvement

Updated 22 March 2018