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

Archived: Harcourt House

Overall: Inadequate read more about inspection ratings

82 Canadian Avenue, Catford, London, SE6 3BP (020) 8695 5656

Provided and run by:
Care + Ltd

All Inspections

3-5 February 2016

During an inspection looking at part of the service

We decided to cancel the registration of this service. This means the provider will no longer be able to operate the service at this location.

We rated Harcourt House as inadequate because:

  • When a patient was restrained this was not always recorded as an incident. Staff did not always recognise physical interventions as restraint. Patient’s physical observations were not taken during or after restraint or rapid tranquilisation.
  • There had been 27 serious incidents in the previous year. The service did not have an incident policy. Not all incidents were reported.
  • One patient had been locked in their room for several weeks. This had not been recognised as long-term segregation. The patient was not detained under the Mental Health Act. This was a breach of the patient’s human rights and amounted to mistreatment.
  • One patient’s bedroom had a stained floor and an overwhelming smell of urine. The service was not clean and was neglected. Redecoration and maintenance were required. The environment was institutional.
  • Patient’s risk assessments did not include all potential patient risks. Risk assessments and management plans were not updated after incidents, including serious incidents.
  • Safeguarding incidents did not always result in a safeguarding referral. Less than 60% of staff had undertaken safeguarding adults training. The provider could not ensure that it could protect patients from avoidable harm.
  • The pads for the defibrillator, to restart a person’s heart, had expired in 2009. An oxygen cylinder was unsecured. Had it fallen it could have led to an explosion of gas.
  • Patients did not receive psychological treatment appropriate to their needs. Patient’s care plans did not include their psychological, spiritual and cultural needs. Patients were not involved in developing their care plans.
  • The number of qualified nurses did not ensure that patients received safe, effective and high quality care. Some staff, including senior staff, were not skilled and experienced in the care and treatment of people with a brain injury. There was a low rate for staff attending specialist training.
  • Patients were not always treated with dignity and respect. Patient’s receiving insulin had to expose their stomach in public to receive their medicine. When staff had contact with patients for physical therapy they wore gloves.
  • Patients reported they did not feel listened to by staff. Patients were unable to access an advocate easily. Patients said they were bored and there were very few activities. There was no activity programme in the service.
  • There was no effective system for ensuring that best practice and legal requirements were met regarding the Mental Health Act and the Mental Capacity Act.
  • There was a lack of clinical audit. Important standards for the care, treatment and safety of patients were not monitored. There had been a systemic failure to assess, monitor and improve the safety, care and treatment of patients.

The provider closed the service two weeks after we conducted the inspection.

23 July 2015

During an inspection looking at part of the service

• This was a focussed inspection. We have not rated the service as we do not rate a service until we have conducted a full, comprehensive inspection.

• At our last inspection we found that the care and treatment was not provided in a safe way for service users. The management of medicines was not safe and proper. In this inspection we reviewed the progress the service had made in safe administration of medicines. The service had made a number of changes and was now complying with the areas identified following our last inspection. However, we found that a number of new concerns with regards to the management of medications.

• At the last inspection we identified that the provider had not acted in accordance with legal requirements in the Mental Capacity Act (2005) (MCA) and the MCA Code of Practice. At this inspection we found there had been a number of improvements and the service was now meeting this standard. However, there remained a number of areas for improvement in embedding staff understanding of the MCA.

• At our last inspection we asked the provider to take action because there was no evidence that people were involved in their care planning process. The provider was now meeting this standard. New care plans had been introduced, which demonstrated involvement from patients in their development. However, some patients did not yet feel fully involved and discussions at the clinical team meeting did not demonstrate involvement of patients.

• At our last inspection the service had not told us that their registered manager had left. Since this inspection the service had provided regular updates to CQC. However, a new manager had not yet been appointed.

• The service had made a number of improvements since our last inspection. Staff were very positive about the impact the new Operations manager had made. However, the service did not yet have an effective system or process to assess, monitor and improve the quality and safety of the services provided. There was no system to review incidents, including those of restraint. Team meetings were not happening regularly.

• The hospital had moved to a new care plan structure at the time of our inspection. Care plans which had been completed were comprehensive and reflected the individual needs of patients.

31 March 2015

During an inspection in response to concerns

We observed care being delivered and spoke with one person who uses the service and three family members of people who use the service. We spoke with nursing and therapy staff and checked records for four patients. We checked records held on site and reviewed information sent to us by the provider. People we spoke with who used the service or whose family member used the service were generally positive. We observed positive interactions between staff and people who use the service during the day. Two family members told us that they had seen progress had been made by their family members who were using the service. Most staff we spoke with were positive about the provider and the support which they received from their line managers.

We checked records and found that there was evidence of a lack of understanding and implementation of the Mental Capacity Act. There was care planning documentation which did not reflect that people had been involved in the development of their care plans and some care plans did not reflect assessed needs.

We noted that the way medicines were managed did not protect people from harm and systems were not in place to ensure that lessons were learnt from medicines errors.

The registered manager was no longer working at the location where they were registered to carry on regulated activities. We were notified of this following the inspection. The hospital had vacancies for nurses and rehabilitation assistants which meant that there had been a high level of agency staff being used which meant there was a risk of inconsistency of service delivery.

3 January 2014

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We read the records for four people who used the service. We saw that the service had obtained the consent from people to care and treatment as outlined in the care plan. One of the people we spoke with said 'Me and my mum and step-dad came to see the service, then we sat down with staff and agreed a treatment plan for me'.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw the records of four people that used the service. All contained referral forms of the organisation that had referred them to the service. Needs assessments were completed by the service prior to people being placed there.

Staff told us that a multidisciplinary approach enabled them to individualise support. A staff member told us 'Care plans are individualised to meet people's specific needs, the level of input from team members is dependent on people's specific needs'.

People were provided with a choice of suitable and nutritious food and drink. We saw a rota of menus and that these were amended according to the preferences of the people who used the service.

The people we spoke with told us 'the food is good' and 'The food is excellent, I can have seconds whenever I want'.

Staff received appropriate professional development. All staff received mandatory and statutory training that was relevant to their role. This included training in subjects such as health and safety, manual handling and infection control. We saw training records that confirmed this.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We read the minutes of the house meetings and found that people had been consulted about the service. Things people were consulted on included: the menu and activities. The people we spoke with told us they were given the opportunity to speak about things they were unhappy about at house meetings. One person said 'if I was unhappy about something I would speak to a member of staff, or talk about it at one of X's meetings'.

12 December 2012

During an inspection looking at part of the service

During this inspection we did not speak with people who use the service, as this inspection was carried out as a follow up to ensure the service had addressed areas of non-compliance we found in our previous inspection of 12 July 2012.

We found that the service had made the necessary improvements and was now compliant with the standards we reviewed.

12 July 2012

During a routine inspection

There were 10 patients at Harcourt House when we visited. Four patients and one relative spoke with us about their experiences of the service. They were positive about the service overall, and spoke well of the staff.

People spoke of having opportunities to be involved in decisions in how the service was run, by attending the regular house meetings arranged by the staff.

There were opportunities for people to go out, as well as take part in activities within the service and in the community.

The provider had suitable arrangements in place to ensure that people were protected from the risks of abuse. Incidents were recorded and appropriate actions were taken in response to them.

We observed staff interactions with people using services as respectful and supportive in most periods during our inspection. However during lunch, we found that people were not always appropriately supported.

Some areas of Harcourt House would benefit from redecoration.

We found that some of the incidents recorded in the service were reportable to the Care Quality Commission (CQC), but that we had not been notified when they occurred.

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.