Archived: Monet Lodge

Monet Lodge provides care for up to 20 older people with complex mental health problems, specialising in dementia care.

Following this inspection, we took urgent action and served a Notice of Decision which placed conditions on the hospitals registration. The Notice of Decision prevented them from admitting any further patients. In addition, it required that all patients received support to be discharged or were found appropriate onwards placements that could meet their needs by 31 March 2022.

Our rating of this location went down. We rated it as inadequate because:

• The service was not safe. It did not have enough nurses to provide care for the patients. Staff did not manage risk well. There were a high level of restrictive practices including enhanced observations (when a specific number of staff stay with patients at all times) with no clear rationale, the use of containment (stopping patients moving freely around the hospital) and the use of mechanical restraint in the form of lap belts and groin straps which stopped patients moving out of their bed or chair. The need for these to be used had not been assessed by a specialist in this area and there was no clear rationale for their use. Staff were sometimes restraining patients and were not trained to do this. This meant that there was a high risk of injury to patients due to incorrect techniques potentially being used.
• Medicines were not always safely managed, and staff had little or no understanding of what constituted a safeguarding concern. Not all staff had the training required to keep patients safe.
• Staff did not develop holistic, recovery-oriented care plans informed by a comprehensive assessment. Information in care plans was often outdated or incorrect. They did not provide a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. There was no access to psychology and patients did not receive input from a clinical psychologist. Clinical audits were not up to date or complete and they were not used to evaluate the quality of care the patients received.
• The ward teams had access to some specialists required to meet the needs of patients at the hospital. However, there was little or no input from specialists such as dietitians, physiotherapists and speech and language therapists. Staff had not received regular supervision and none of the staff had received an annual appraisal. Decisions made at multidisciplinary team meetings were often not acted upon by the wider staff team, this was in part due to a lack of permanent staff at the hospital.
• Staff did not understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. We found that staff made the assumption that patients lacked capacity without undertaking any assessments of their capacity. Families were often asked to sign for decisions without consulting the patient first and outside of a legal framework. It was difficult to identify which patients were detained under the Mental Health Act (MHA) or were subject to a Deprivation of Liberty Safeguard as recording in patients' notes was poor and staff had little knowledge and understanding of their responsibilities. The lead for the Mental Health Act had left the organisation and although the provider had organised some cover for this, there were no staff who were formally trained in the MHA to ensure that obligations under the Act were carried out.
• Staff did not always treat patients with compassion and kindness and did not respect their privacy and dignity. We saw many examples of this during our two-day inspection. We saw that staff often talked over patients, ignored patients, and talked about their personal hygiene needs in the main lounge. Patients were told to sit down whenever they tried to get up.
• Staff did not understand the individual needs of patients. Some staff we spoke with did not know the names of the patients they were looking after. We found that care plans did not contain information about the patients’ lifestyle, hobbies, and family. Care plans were often generic containing information that did not refer to the patient in a meaningful way. Staff did not involve patients in any decisions about their care, although families were asked to review care plans and sign them.
• We found that many patients at the hospital were ready for discharge but there had been no attempt to support patients to move on from the hospital. Following our enforcement action, all patients were reassessed and only four of the eighteen patients were found to require continued hospital care. The lack of skilled staff at the service to assess patient needs meant that patients stayed in the hospital for much longer than they needed to.
• The service was not well-led, the registered manager had left and although a new manager had been brought in the provider lacked oversight of the service provided at the hospital. The governance processes did not ensure that ward procedures ran smoothly.

However:

• The environment was clean and well furnished, with dementia friendly signage.
• There was evidence of good working practice between the GP and consultant psychiatrist.
• Some carers were positive about the care provided to their loved ones.