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

Nelson House

Overall: Requires improvement read more about inspection ratings

14 Rowner Road, Gosport, Hampshire, PO13 0EW 07590 001012

Provided and run by:
Partnerships in Care 1 Limited

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

All Inspections

08, 09 and 16 August 2023

During an inspection looking at part of the service

Long stay or rehabilitation mental health wards for working age adults.

Nelson House is a purpose-built 32-bedded independent hospital, operated by the Priory Group, that provides assessment and treatment for men within a locked rehabilitation setting.

The environment was recently re-designated to better meet the purpose of the service. Patients arriving at the service were admitted into Trafalgar Ward and when they were on a discharge pathway moved into Victory Ward for rehabilitation.

At the time of the inspection, the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out this focused inspection since the comprehensive inspection in January 2023. We had concerns about the quality and safety of services. There were recurring themes on the safety of patients, and we were concerned there were risks and that serious incidents would occur.

We inspected Nelson House on 3 occasions since CQC introduced the rating approach of services. Nelson House was rated Requires Improvement in Safe on all inspections and in January 2023 we set requirement notices in care plans and risk assessments and medicines. We asked for the action plans to be submitted 14 days from the publication of the final inspection report dated January 2023. However, these were not provided until the visit in August 2023. The emerging oversight from our visits demonstrate continuous themes and slow to improve areas raised during previous inspections.

Following the inspection we issued a Warning Notice under Section 29A of the Health and Social Care Act 2008 due to our concerns that patients were not receiving safe care and treatment under regulations 12 and 17 of the Health and Social Care Act 2008 (regulated activities)

10 -11 January2023

During a routine inspection

Nelson House is a purpose built 32-bedded independent hospital, operated by the Priory Group, that provides assessment and treatment for men within a locked rehabilitation setting.

The environment was recently re-designated to better meet the purpose of the service. Patients arriving at the service were admitted into Trafalgar ward and when they were on a discharge pathway moved into Victory ward for rehabilitation.

At the time of the inspection, the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is ran.

We rated this service Requires Improvement because:

Governance Systems were not robust as audits had not identified all shortfalls to improve outcomes for patients.

Care plans were not devised for all identified areas of need. They lacked patients' preferences on how they wanted their care needs to be met and recovery plans were not aligned to the core care plans. There were inconsistencies from staff on their roles and responsibilities with supporting patients with rehabilitation which had created a disconnect between the Occupational Therapy team and support workers. This meant patients were not having person centred care

Medicines management systems were not always well managed. These included containers without lids for medicines no longer required, poor communication between the staff and the supplying pharmacist and internal guidance was not being followed for medicines with additional recording schedules.

There were blanket restrictions. There were smoking breaks known as “protective times” when patients were able to smoke despite a smoking cessation programme. There was an expectation that informal patients return to the hospital before 10pm.

Patient’s consent was not gained to have their initials against comments and suggestions made in public documents.

The external environment was not maintained. Parts were overgrown, there was litter and cigarette stubs which increased the potential risk for the spread of infection.

There was poor visibility from the office into the wards. Staff were sitting in offices without having the light switch on due to the poor visibility from the office made worse by the panels of frosting on the glass panels.

However:

Staff felt valued and morale was improving where it was previously low. Internal training was due to be delivered to ensure staff knew their roles and responsibilities. There was to be team building to develop better ways of working between multidisciplinary teams.

The second floor environment was adapted to provide rehabilitation for patients on a discharge pathway.

Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly

Patients had access to a range of treatments suitable to the needs which included emotional and social support.

Staffing levels were maintained with permanent and regular agency staff.

Staff recognised and reported incidents appropriately

Patients felt confident to approach staff with complaints

17 and 18 July 2018

During a routine inspection

We rated Nelson House Hospital as good because :

  • The staff carried out checks of the hospital to ensure it was safe and the hospital was in a good state of repair. There was a good incident reporting culture and staff learnt from incidents to help prevent them happening again.
  • There was a multidisciplinary team working at the hospital and they offered a full therapeutic programme to meet the needs of the patients. The hospital followed National Institute of Health and Care Excellence guidance and completed comprehensive assessments of patients on admission to meet their needs. Staff completed and updated risk assessments for each patient and used these to understand and manage risk.
  • The staff understood their responsibilities under both the Mental Health Act and Mental Capacity Act.
  • Patients and carers reported that staff treated them with respect and that the care given was good. Staff actively encouraged patients to give feedback to help develop the service. Care focused on increasing independence.
  • Patients were involved in discharge planning.
  • Staff planned activities based on patients’ likes and needs. There were activities both on and off the wards seven days per week.
  • The service had an open culture when dealing with complaints.
  • Local managerial and clinical leadership was strong. The service used the providers visions and values to plan the future of the service. There were governance structures in place that helped drive improvements.

However:

  • The senior management team had not identified that a wide range of blanket restrictions where being used to manage risk to all patients in the hospital. The staff team were using blanket restrictions rather than undertaking individual risk assessments, managing risks in accordance with those risk assessments and only using blanket restriction where absolutely necessary.
  • Not all bedroom doors had observation panels that staff could lock to ensure individuals privacy could be maintained.
  • The staff did not provide patients with care plans in an easy to understand format. Staff did not agree advanced directives with patients about their care.

7 and 8 February 2017

During a routine inspection

We rated Nelson House as requires improvement because:

  • In January 2016, we rated Nelson House as requires improvement. During this inspection (February 2017), although some progress had been made, this was not sufficient to amend the ratings for Safe, Caring, Responsive and Well Led. However, we were able to re rate Effective from inadequate to requires improvement.

  • Nelson House had 32 beds and at the time of inspection, there were 18 patients. At the last inspection in January 2016, the provider had decided to restrict new admissions to allow staff to embed quality improvement changes. In January 2017, the provider closed the wards to all admissions, as staff had not embedded all of the identified quality improvements appropriately.

  • At the previous inspection in 2016 the provider did not have effective systems and processes to assess, monitor and improve the quality of the service. This meant that they did not consistently identify and assess risks, monitor progress against plans to improve or take appropriate action where progress had not been achieved. During this inspection, we found that a number of issues identified in our January 2016 inspection had not been addressed effectively.

  • At the last inspection in 2016, we identified that the leadership at Nelson House was not robust. At this inspection, leadership had not improved. Staff did not feel confident about raising concerns with the hospital manager. Sickness was high. The total absence percentage for Nelson House is 5.65% between January 2016 and January 2017. The average number of leavers per month was two.

  • At this inspection we identified a number of health and safety concerns. Staff precooked food on a weekday and left it in the fridge with instructions on for the weekend staff to serve it. Staff did not record food temperatures. The kitchen was in need of a deep clean. The provider did not have an up to date legionella safety certificate. In addition, the provider had not carried out environmental work identified at the January 2016 inspection that was necessary to minimise the likelihood of risks to patients and /or staff. For example, to address blind spots and ligature risks (anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation).
  • At the previous inspection in January 2016, attendance of mandatory training was low. At this inspection, we saw that training had started to improve. However, completion of key subjects remained low. For example, only 25% of staff completed infection control and 43% completed safeguarding adults level one. The provider reported no concerns about staffing levels. However, at the time of the inspection there were 15 vacancies, this had increased since the last inspection in 2016 when they had eight vacancies.
  • Patients reported staff sometimes cancelled activities due to staff shortages. The Clinical Psychologist was unavailable but they had recruited a social worker. The majority of staff had not received supervision since 2013.

However, we also found the following areas of good practice:

  • Staff treated clients with kindness, dignity, and respect. The staff we met were conscientious, professional and committed to doing the best they could for the people in their care.

  • We discussed our immediate concerns with the new Priory Group management team who were taking over the governance of Partnerships in Care. They had a good understanding of the current performance issues and had developed an action plan to address them. The provider was also responsive to all requests for action to be taken at the time of inspection.

12 - 13 January 2016

During a routine inspection

We rated Nelson House as requires improvement because:

  • We rated effective as inadequate. Care plans completed by staff were not personalised and did not capture patients’ views. Appropriate information to provide care for patients was not contained in the care plans. Care coordinators confirmed that there had been a lack of meaningful activity focussed on patient recovery. The provider had identified this and had started a new activity programme the week before the inspection.

  • Staff had not received regular clinical supervision to review their work and their approach towards it. Staff had not had annual appraisals to discuss their progress and identify training needs and career aspirations.

  • Staff did not follow the ligature point (anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation) management plans consistently. Staff had developed these plans for patients identified as at risk of self-harm using a ligature. The hospital’s audit of ligature points was incomplete; however, there were very few ligature points due to the hospital’s modern design.

  • Staff did not document patients’ risks consistently using recognised risk assessment tools.

  • The hospital placed unnecessary restrictions on all patients. These included patients not being able to access the hospital garden for fresh air or to smoke when they wished. Patients without a personal mobile phone could not make private phone calls.

  • Patient records were inconsistent and staff could not always find documents relating to patient care.

  • In an emergency staff could not access emergency equipment, including a defibrillator, in a timely manner as they had to run down several flights of steps or take a lift to collect these.

However:

  • Staff interactions with patients we witnessed were respectful and polite. Staff demonstrated knowledge of patients’ histories and holistic needs.

  • Staff were very positive about the developments and changes that had been made since the change of ownership. They told us they felt safer and that a more structured approach had improved relationships with the patients.

  • There were good governance structures for incident reporting and evidence of staff learning from incidents.