Archived: Abbey Court Independent Hospital

Summary of findings

 We rated Abbey Court as requires improvement because:

• Neither ward complied with Department of Health (DoH) guidance on same-sex accommodation because there were no separate lounges for male and female patients. The DoH (2015) states that women-only environments are important because of the increased risk of sexual and physical abuse and risk of trauma for women who have had prior experience of such abuse.
• Staff did not always complete a physical health assessment of every patient, both on admission to the hospital and as appropriate thereafter. Staff did not always fully record patients’ physical health observations. This meant that staff did not have all the information available to make a prompt intervention should a patient’s physical health deteriorate. However, staff did work well with other specialist services, such as GPs, dieticians, physio-therapy and tissue viability to optimise patients’ physical health.
• Staff did not always explain to patients what their rights were when detained under the Mental Health Act (MHA). Where patient rights were explained, this was not routinely captured in patient care records. Where patients had been identified as lacking the capacity to understand their rights, their nearest relative had not been informed. This was partially mitigated because staff routinely referred patients detained under the MHA to Independent Mental Health Advocates. The advocates regularly attended the wards to offer independent advice and support.
• At the time of our inspection, there was limited occupational therapy input into the hospital, including a specialist occupational therapist in dementia care.
• This meant that specialist occupational therapy assessments were not always completed, specifically the ‘functional behaviour profile’ for patients diagnosed with dementia. This assessment was important because it should be used to assess how much assistance a patient with dementia needs to perform activities of daily living, such as washing, dressing and eating. The assessment should then form part of a patients care plan. Senior management assured us that funding had been secured to recruit an occupational therapist in March 2016.
• The hospital had a high staff vacancy rate at a total of 17%, and a high a long-term sickness and absence rate at 11%. This meant that the hospital relied heavily on nursing agency staff that were not able to perform all the duties of a nurse employed directly by the hospital. Such duties included acting as a named nurse for a patient, which involves completing and regularly reviewing patient care plans and assessments. Consequently, we found that there were not enough named nurses to ensure that all care plans and assessments were fully completed and regularly reviewed thereafter.
• The hospital identified that any patient who had lived at Abbey Court for more than eighteen months, and had completed their treatment programme, were a delayed discharge. Although the hospital was actively working towards discharging patients to a community setting, four patients on Crossfield ward had been at Abbey Court for over eighteen months.
• Not all staff members were provided with a regular opportunity to provide feedback into the running of the hospital. This had had an impact on staff-morale.Senior management were aware of this and had plans in place to establish regular team meetings for all staff.

However:-

• Other than its failure to adhere to guidance on same-sex accommodation, the unit environment reflected best practice in dementia care. It had consistent flooring throughout the communal areas and contrasting handrails. Memory boxes were in place outside patients’ bedrooms. These contained sentimental items, such as family photographs and post-cards, that patients were able to relate to as being significant to them. This helped patient’s identify their own bedroom.
• The hospital demonstrated a strong commitment to introducing innovative and evidence based ways of working with patients diagnosed with dementia. This included the activating communication potential group for patients who had difficulty communicating their needs verbally. They also used the pool activity level assessment tool to develop personalised activity plans for patients with dementia. The hospital was also committed to developing staff skills and knowledge base in evidence based dementia care. This included providing specialist staff training in the dementia care matters initiative for person centred care, called the ‘footsteps’ training programme.
• For patients who did not have the capacity to provide meaningful input their care plan, staff used person-centred documents, such as ‘this is me’, to ensure that patients’ views and preferences were captured. This included information about a patient’s hobbies, significant family members and what they liked to eat and drink.
• Patients’ care records were comprehensive and contained assessments and care plans that related to patients’ individual needs. Staff regularly monitored and assessed patients’ nutritional and hydration needs.
• All carers we spoke with were positive about the care their relative had received. Carers said that staff were highly skilled and motivated to meet individual patients’ needs.
• The hospital had formed effective relationships with other agencies that were involved in the care of patients at Abbey Court. This included the local clinical commissioning group, local authority and primary care services. The hospital worked in partnership with a local NHS Trust to deliver specialist dementia training to five local care homes. The hospital was also a member of the Warrington Dementia Alliance Association (WDAA). The WDDA worked together to raise awareness and improve service provision within the local community for patients diagnosed with dementia.
• There was an established care pathway for patients admitted to Abbey Court. All patients were admitted from one ward based at a local NHS Trust. Three of the consultants psychiatrists employed by Alternative Futures Group worked between the ward and Abbey Court. This meant that patients received continuous care from the same consultant psychiatrist when moving from one service to another.
• All staff received supervision every six to eight weeks. All staff received an annual appraisal of their work performance. Staff we spoke with said that the senior management team were supportive and approachable.
• The provider had a comprehensive mandatory training package that included a support essentials programme.  This comprised seven courses, including health and safety, food hygiene, manual handling, fire awareness, infection control, safeguarding, and basic first aid. All staff had completed the support essentials course.  Agency staff training was compatible with that provided by Alternative Future’s Group.