The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: The Limes

Overall: Good read more about inspection ratings

Main Street, Langwith, Mansfield, Nottinghamshire, NG20 9HD (01623) 746002

Provided and run by:
Cygnet Behavioural Health Limited

Important: The provider of this service changed. See new profile

All Inspections

22 November 2016

During an inspection looking at part of the service

We rated Cambian – The Limes Hospital as good for effective because:

During this most recent inspection, we found that the provider had addressed the issue that resulted in us rating the service as requires improvement for the effective domain in April 2016, by updating its Mental Health Act policies to reflect the revised Mental Health Act Code of Practice.

  • The multidisciplinary team worked together to identify and meet the needs of patients. The team used the National Institute for Health and Care Excellence guidance to inform the care they provided.
  • The manager supported the staff team by ensuring regular supervision and appraisals took place. This allowed the manager to identify development needs or issues in a timely manner.

20/04/2016

During a routine inspection

We rated The Limes Hospital as GOOD because:

  • The premises were clean and well maintained. There was a comprehensive programme of individual therapeutic activities to help patients achieve their recovery goals.
  • The hospital’s system of documenting patients’ care plans was multidisciplinary in approach and we saw clear evidence of recovery focus, personalisation and patient involvement.
  • The multidisciplinary team completed a robust assessment and review of risks for each patient and developed plans to manage these. The team reviewed risk assessments following any incidents.
  • There was a good system of feedback to the staff team from audits, incidents and complaints. The hospital made changes in line with recommendations from incident investigations demonstrating lessons learnt.
  • All staff received appropriate supervision, appraisal and training to help fulfil the requirements of their roles.
  • We saw evidence of patients being involved in the planning and review of their care and treatment. There were advanced decisions documented in patients’ care plans.
  • The hospital catered for patients of different cultures, languages and religions.
  • The local management of the hospital provided effective leadership and support to the staff team. The staff team was cohesive and worked collaboratively to meet the needs of patients effectively.
  • The hospital had robust and effective systems in place to measure the performance of the service and was involved in research on developing outcome measures.

However:

  • Mental Health Act (MHA) policies did not reflect the changes to the Code of Practice in April 2015. Cambian Healthcare Limited had an action plan to complete this task by 30 April 2016. However, this was not appropriately timely given the change in policy took place in April 2015 12 months prior to inspection.
  • Several recent shifts did not have two qualified staff due to a qualified nurse vacancy for which recruitment was underway.
  • Following the recent reduction in psychiatric input, there was no review or audit undertaken to evidence there was sufficient psychiatric input to meet the needs of the patients at the time of inspection.
  • Some patients told us that when not receiving individual sessions they experienced periods of inactivity. However staff informed us that patients could choose to attend ad-hoc activities on a daily basis and staff offered attendance of these activities to promote periods of activity throughout the day.
  • Recording of the rationale for prescribing medication above the British National Formulary (BNF) limits could benefit from further detail.

26 February 2014

During a routine inspection

At our visit there were 17 patients receiving care and treatment at The Limes Hospital. There were 15 patients who were detained there under the Mental Health Act 1983 and two patients who were informally admitted there.

We found that patients experienced care, treatment and support that met their needs and protected their rights. They were cared for by staff who were supported to deliver care safely and to an appropriate standard. Patients diversity, values and human rights were mostly respected.

Patient's privacy, dignity and independence, was respected and their views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Patients were given appropriate information regarding their care and treatment and were well supported in promoting their independence and community involvement.

One patient told us how they felt supported to gradually build their leave time away from the hospital. They said, 'I've been in places not as good; they give me a chance of freedom here.' Another patient told us, 'Staff, are kind and respectful.'

We found that patients were protected against the risks associated with unsafe medicines practice. People who used the service, visitors and staff were protected against the risks of unsafe or unsuitable premises.

5 March 2013

During a routine inspection

There were 18 patients receiving treatment at The Limes at the time of our visit. A further three patients were receiving out patient treatment at The Limes whilst they were living in step down houses owned by the provider.

We spoke with three patients receiving treatment at The Limes. Overall, they were positive about the support they received from staff and they told us that they had felt better since moving to the hospital. One patient said, 'It's much better here than where I was before, the staff are great and there are lots to do.'

During our visit we looked at issues which had been identified by the Care Quality Commission Mental Health Act Commissioners during a visit to the hospital in June 2012. The Commissioners had visited to speak with patients who were detained under the Mental Health Act 1983 (MHA). We found that all of the issues had been addressed.

We found that patients needs were being met and that a multi-disciplinary team was involved in patients treatment at The Limes. Patients were encouraged to become more independent and were involved in their treatment as much as possible.

We noted that there were inappropriate arrangements in place relating to the administration of some medicines. This meant that patients were not consistently protected against the risks associated with the unsafe use of medicines.

During a check to make sure that the improvements required had been made

This review was conducted using evidence and documents sent to us by the provider to inform us of the progress made after our visit on 12 January 2012.

We found that the provider has systems in place to recognise and respond to allegations of abuse which ensure that consideration is given as to whether these should be shared with the local authority under multi-agency procedures or the Care Quality Commission.

The provider's incident records from the last six months showed that appropriate actions had been taken in response to concerns identified.

12 January 2012

During a routine inspection

The patients we spoke with told us they knew and understood the treatment and support choices available to them. Comments included, 'I have regular meetings about my care programme and staff always do this in private. Staff respect me and I respect them.'

Patients could express their views and were involved in making decisions about their care, treatment and support. Comments included, 'Staff have told me about my treatment plan and my detention and I understand the conditions of my stay here. I have been involved in decisions about my care and support.' 'I have a copy of my care plan, self medicating plan and therapeutic programme which is mine to keep.'

Patients we spoke with told us they felt safe, comments included, 'I'm here voluntarily as an informal patient, I had a choice. I feel safe here, they respect you.'

Patients told us they were happy with the accommodation provided and felt that they benefitted from the care and treatment provided at the Limes Hospital.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.