Archived: Vista Healthcare Independent Hospital

Following the inspection in November 2014, we have continued to attend regular meetings involving NHS England, commissioners, the local authority and the provider, and these have involved a regular review of the provider's action plan. During these meetings the hospital`s management of safeguarding was discussed. Those attending the meeting considered the quality of the processes in place for monitoring and managing safeguarding issues, and found them to be poor. The local authority indicated that there was a backlog of outstanding information they were waiting for, and that they regarded it as urgent because they would not be able to make progress with the referrals without that important information.

Some patients we spoke with told us that they were happy with their care. Some patients continued to raise concerns with us about their care and told us that they did not feel safe on the wards. The commissioners and NHS England had been working with Vista to move some patients to alternative placements, as they recognised that they were unable to meet their needs. We noted that this had a positive impact on some of the wards, with staff and patients feeling safer. Some staff told us that they felt more supported by the new management team. However, we found that there were still some serious concerns with care and safety of patients, particularly on Prandle Ward and Watson Ward.

In conclusion, evidence collected during the inspection on 3, 4 and 5 February 2015 and other sources, highlights that Vista Healthcare Independent Hospital has failed to address the areas of concern, in relation to safeguarding, from the inspection in November 2014. As a consequence Vista has continued to fail to comply with regulation 11 of the Health and Social Care Act 2008, despite being served a warning notice to improve. We have taken further enforcement action and served two Notices of Decision. The first notice served prevented any admissions to Vista Healthcare Independent Hospital. The second notice served prevented any regulated activities taking place on Watson ward, the male low secure facility. NHS England worked closely with Vista to move patients from Watson ward to alternative healthcare providers, who were able to provide safe and effective care and support that the patients required.

We attended a multi-agency large scale safeguarding meeting 31 October 2014, held by the local authority. We examined all of the information we held about this provider. On 5, 6 and 12 November 2014, we carried out site visits at Vista Healthcare Independent Hospital (`the hospital`). We observed in detail how people were being cared for. We talked with 16 people who used the service and five carers. We talked with 39 members of staff, including ward staff, allied health professional staff, the health and safety manager, the security manager and the domestic services manager. We spoke with the chief executive and both clinical directors. We also spoke with all the advocacy services that visit the hospital.

During our inspection, we looked to see whether the provider had a satisfactory system in place to allow them to regularly assess and monitor the quality of the services provided in carrying out the regulated activity. We also reviewed other records related to providing care and supporting staff; including care records, staff files, audits, systems to assess and monitor risks, complaints and compliments and policies and procedures.

Some patients told us that they were well cared for and they had no concerns about the staff. Some patients felt angry and frustrated by how they were treated. They told us that staff did not listen to them and did not treat them with respect. We found that some staff had a good knowledge and understanding of their patient`s needs, and we observed some examples of calm, caring interactions between staff and patients on some of the wards. However, we also observed poor interactions and met staff on all the wards who did not have a good understanding of patient needs and we were concerned about their competency to care for people safely.

Having considered all the available information, we concluded that:

Vista Healthcare Independent Hospital did not take proper steps to ensure that people who use the service were protected against the risks of receiving care or treatment that was inappropriate or unsafe as the planning and delivery of care did not meet people's individual needs. There was a lack of understanding of the complex needs of people. The planning and delivery of care and treatment did not reflect the current guidance contained in Positive and Proactive Care: reducing the need for restrictive interventions, (Department of Health, April 2014). The lack of sufficient suitably skilled and experienced staff and poor clinical leadership meant that the culture of restrictive practices and poor knowledge and skills had not been identified nor had action been taken to address it.

Vista Healthcare Independent Hospital did not operate effective recruitment procedures and did not take appropriate steps to ensure all persons were fit to deliver the regulated activity. For example, by failing to carry out the relevant checks and interview processes.

Vista Healthcare Independent Hospital had failed to ensure that each person was adequately protected from risk, including the risks of unsafe practices by its own staff. Investigations carried out by the registered provider into the conduct of persons employed at Vista Independent Healthcare were not robust and had not safeguarded people.

Vista Healthcare Independent Hospital failed in relation to their responsibilities by not providing the appropriate training and supervision to staff, which would be required to enable them to deliver safe and effective care and treatment to the people who use the service.

Vista Healthcare Independent Hospital did not protect the people who use this service against the risks of unsafe care and treatment due to the ineffective operation of systems. The registered provider did not have robust systems to assess and monitor the quality of services provided in the carrying on of the regulated activities.

Vista Healthcare Independent Hospital did not identify, assess or manage risks relating to the health, welfare and safety for the people who use this service. The registered provider had not responded to complaints and comments made and had not considered the views, including the description of their experience of care and treatment, expressed by people who use the service, and those acting on their behalf.

Vista Healthcare Independent Hospital did not take reasonable steps to identify the possibility of abuse and prevent it before it occurred. It also did not respond appropriately to allegations of abuse. Where a form of restraint was used the registered provider did not have suitable arrangements in place to protect the people who used this service against the risk of control or restraint being unlawful or otherwise excessive.

The CQC arranged to meet with the provider to discuss our findings and concerns. The provider agreed to put a specialist team in place to help support staff to make the changes needed. The provider also agreed not to admit any more patients until changes had been made. We informed the local authority, NHS England and the other commissioners of our concerns.

We found that the hospital gave people as many choices as appropriate and possible. Care plans noted what choices people were able and permitted to make for themselves. Staff we spoke with demonstrated a good understanding of people's needs and the ethical issues involved in treating people who were detained.

Overall staff felt supported in their role, training provided was good and there were opportunities for staff to discuss issues with colleagues and managers.

The wards seen were clean and hygienic but were not very homely. Some communal areas and some bedrooms were 'stark' and did not present as a comfortable living environment for patients. We found that the hospital had ways of looking at the care they offered so that they could make sure they maintained and improved it. They listened to the views of the patients and acted on them if they could.

There was a range of activities available which people could choose to participate in. Meetings were held with people on a daily basis to discuss how the ward operated and what activities people wanted to participate in. One person said 'The activities are ok', another person told us 'I'm now allowed to go out unescorted. I am really happy about that'. Information was displayed at several points around the ward to inform people about a range of topics.

Overall staff felt supported in their role and had regular meetings and one to one supervision sessions.