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Inspection Summary


Overall summary & rating

Good

Updated 22 September 2017

We rated Monet Lodge as good because:

  • The ward was clean, tidy and well maintained. The clinic room was fully equipped and emergency equipment was checked regularly. Staff were aware of how to report incidents and all staff had access to the online reporting system. There were single sex ensuite bedrooms and a separate female lounge in accordance with same sex guidance. There were good systems in place for ordering, dispensing and storage of medications. Staff were aware of their responsibilities under duty of candour.
  • There was good evidence that National Institute for Health and Care Excellence guidance was being followed in relation to prescribing and monitoring of medication and non-pharmacological treatments for dementia. Staff completed a physical health check on admission and these were regularly reviewed throughout the patients stay at Monet Lodge. Mandatory training was at 86% and staff took part in clinical audits including medications, care records and mental health act documentation. Staff had a good understanding of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. The service adhered to the Mental Health Act and the revised Mental Health Act Code of Practice. Mental Health Act documentation was complete and correct.
  • Staff engaged positively with patients and their carers. All interactions we observed were respectful, kind and maintained the dignity of the patient. Carers and relatives told us that the staff were friendly and approachable and always took the time to speak to them and involve them in their loved ones care.
  • There was a full range of rooms to support the care and treatment of patients with complex needs. There was a good variety of activities available to patients seven days a week. Information was available in easy read format and in other languages if required. There was access to spiritual support and the chef was able to provide food for any specialist needs such as vegetarian, vegan, halal and kosher. Patients had access to an independent mental health advocate who visited the hospital and attended care programme approach meetings if patients wanted them to.
  • Staff were aware of the organisations vision and values and these underpinned all the work they did. These were incorporated into staff meetings, supervision and the key performance indicators for staff. The staff felt supported by the manager and the clinical lead and felt that their suggestions about the service were listened to.

However,

  • On the day of our inspection, the clinic room floor and worktops were dirty and the plastic suction tip on the suction machine was uncovered. On our return to the hospital this had been rectified and the room was added to the cleaners schedule for a daily clean.
  • The ligature knife was locked in a drawer that not all staff had a key to.
  • The clinic room temperatures were found to be over 25 degrees Celsius on a regular basis.

  • Due to the amount of care plans some patients had (up to twenty) we found that some care plans were generic and not person centred. We found one example where the patient was referred to as “he” when the patient was a “she” and one with another patients name in.
Inspection areas

Safe

Good

Updated 22 September 2017

We rated Monet Lodge as good because:

  • The ward was clean, well maintained and furnishings were of a good standard. The environment reflected best practice dementia guidance with contrasting colours for orientation, dementia friendly signage and good levels of lighting throughout.

  • The clinic room was fully equipped and emergency equipment was checked regularly.

  • There were nurse call buttons in bedrooms and bathrooms.

  • Staff were aware of how to report incidents and all staff had access to the online reporting system.

  • There were single sex bedrooms with showerooms en suite and a separate female lounge in accordance with same sex guidance.

  • There were good systems in place for ordering, dispensing and storage of medications.

  • Mandatory training was at 86%

  • Staff were aware of their responsibilities under duty of candour.

However,

  • On the day of our inspection, the clinic room floor and worktops were dirty and the plastic suction tip on the suction machine was uncovered. On our return to the hospital this had been rectified and the room was added to the cleaners schedule for a daily clean.

  • The ligature knife was locked in a drawer that not all staff had a key to.

  • The clinic room temperatures were found to be over 25 degrees Celsius on a regular basis.

Effective

Good

Updated 22 September 2017

We rated effective as good because:

  • All patients had a full assessment on admission. This included physical health checks that were ongoing throughout the patient’s admission.

  • The provider’s specialist dementia team supported the service to carry out best practice in dementia care.

  • There was good access to a range of health professionals. This included a GP with a special interest in dementia care, physiotherapists, occupational therapists and dieticians.

  • Staff received supervision every two months, this was done using a set format, which included discussions about workload, training and professional development.

  • Staff were involved in clinical audit. These included audit of care records, medication charts and compliance against the Mental Health Act and Mental Capacity Act, amongst others. These were done by the relevant member of the team and fed back to the via individual supervision and team meetings.

  • Staff received specialist training relevant to their role for example, mentorship training, end of life care training and dementia friend training.

  • Life story work and activity care plans were person centred and showed good carer and relative involvement.

However,

  • Some patients had up to twenty care plans which meant that some had become generic in their content. In one care plan we found “he” when the patient was female and another care plan contained the wrong name. This was picked up in the care plan audit but had not been rectified. We raised this with the registered manager who ensured the errors we had found were rectified immediately.

Caring

Good

Updated 22 September 2017

We rated caring as good because:

  • We observed many interactions between patients and staff. All of these were done in a respectful way to ensure the needs of the patient were met whilst maintaining dignity and providing emotional support.

  • Staff had a good understanding of the patients they were caring for, this included not only knowledge about their illness but their families, hobbies and past jobs.

  • There was access to an advocacy service who visited the ward on a regular basis. They gave positive feedback about the hospital.

  • All relatives we spoke to gave positive feedback about the hospital and its staff. They felt staff were approachable and were always willing to make time to speak to them.

  • There was flexible visiting arrangements in place so that relatives could visit at a time that was convenient for them. If appropriate relatives were invited to remain at mealtimes to assist their loved one to eat.

  • There were monthly tea parties where relatives and carers were invited to attend to spend the afternoon with staff and their loved ones.

Responsive

Good

Updated 22 September 2017

We rated responsive as good because:

  • Beds were available for patients in the area when they needed them, there were no waiting lists and there were no out of area placement in the six months leading up to our inspection.

  • There was a full range of rooms to support treatment and care. This included a communal lounge, bedrooms with en-suite facilities, quiet indoor courtyards and a hair and beauty salon.

  • The unit employed a wellbeing co-ordinator three days a week. They supported staff and offered patients a range of dementia-friendly activities tailored to their individual needs.

  • Staff worked with relatives to complete life story type documents that detailed the patient’s interests and hobbies. This included a memory box outside each bedroom that contained pictures and memorabilia from the patient’s life.

  • There was information about complaints clearly displayed on the ward. This was also included in the ward information booklets. Relatives we spoke to told us they knew how to complain and would feel comfortable speaking with staff for support.

  • There was a good choice of food for patients and alternatives should the patients not like what was on offer for that day. This included sandwiches, jacket potatoes or soup as well as a full hot meal. As the chef managed the food they were able to order food for any speciality diets, for example, vegetarian or food to meet the needs of different religious groups.

Well-led

Good

Updated 22 September 2017

We rated well-led as good because:

  • All staff and managers knew the organisations vision and values. These were used in all aspects of work including supervision, annual appraisals and key performance indicators for staff. These were reviewed annually with views sought from staff and patients.

  • There was high morale in the staff team and the staff we spoke to told us they felt supported and listened to by the manager and the clinical lead.

  • The provider, Making Space, funded a dementia space team that provided expertise on best practice in dementia care, and helped the service identify areas for improvement.

  • Monet Lodge was working in partnership with Dementia Space and Dementia UK to develop an Admiral nurse role within the service. An Admiral Nurse is a specialist dementia nurse who provide expert advice and support to families living with dementia. An existing member of the nursing staff was receiving funding and support to complete the relevant qualifications.

  • The manager and clinical lead felt empowered to carry out their role as well as being supported by their immediate managers.
Checks on specific services

Wards for older people with mental health problems

Good

Updated 22 September 2017