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Inspection Summary


Overall summary & rating

Good

Updated 1 December 2017

We rated Knightsbridge House as good overall because:

  • The level of care and commitment from staff towards patients was outstanding. There was a real sense of community spirit at Knightsbridge House. Where possible, patients were actively supported to take ownership of their lives, care and treatment. A ‘this is me’ system was in place which held details specific to each individual patient’s needs. A recovery tool called life star was being introduced, that promoted independence, choice and wellbeing. Staff were also being trained in person centred care planning. There was a ‘my day’ system in place that offered patients the opportunity to make recreational plans outside of their usual routine. Staff who were new or unfamiliar with the patients held prompt cards on their person to guide them as to each patient’s needs. Some patients had assumed roles within the building, supporting staff in their daily activities. This helped build confidence and strengthen independence.

  • The leadership within Knightsbridge House was visible and accessible. Governance procedures were in place to ensure a high standard of care delivery at all times. Medicine management arrangements were good as were all legal requirements surrounding the MHA and MCA. There was easy read information available, including information about the MHA and MCA. Where restrictions were in place, this was clinically justified and risk assessments completed, sometimes with the assistance of patients.

  • The environment was clean and inviting. Cleaning schedules and environmental assessment were in place. All patients had their own bedroom and bathroom facilities where they were supported by staff to take care of their own personal space. All patients had a personal emergency evacuation plan in place.
  • However:
  • Although overall, statutory and mandatory training completion rates for staff were good, there were some subjects, including infection control and life support training, that many staff had not completed training in. This was due to the transition between one company to another as some training requirements had changed. However, staff were now booked onto training. Not all staff had received regular supervision but this was being addressed.
Inspection areas

Safe

Good

Updated 1 December 2017

We rated safe as good because:

  • There were measures in place that meant staff could observe patients in all parts of the hospital building. The use of CCTV, relational security and observations supported this.
  • There were ligature points within Knightsbridge House but an up to date ligature risk assessment had been completed and all areas had been covered. In some bedrooms personal items were missing off the ligature assessment; however, these were added during the inspection.
  • Emergency medical equipment was checked regularly by staff and records confirmed this. Medication management procedures were in place. Fridge temperatures where medication was stored were within range and checked regularly. Rapid tranquilisation practises were in line with hospital policy.
  • A support services manager had been appointed who had full oversight of all maintenance and cleaning schedules. The building was clean and orderly. Cleaning schedules were in place and complete. Quality walkabouts were also being completed on a regular basis.
  • Staff carried personal alarms which would be used to call for assistance during times of psychiatric or medial emergency.
  • Staffing vacancies existed but most had been recruited to. In addition, the hospital had undertaken a staffing review and were increasing their registered nurse numbers to two each shift.
  • We reviewed five care records and found that all patients had a risk assessment completed on admission. Any identified risks were then translated into plans of care.
  • Staff we spoke with understood safeguarding and knew when and how to report safeguarding concerns. Staff we spoke with knew how to report incidents and what type of incidents should be reported. All patients had a personal emergency evacuation plan in place.

  • Incidents were reviewed, discussed and monitored through the local governance committee.

However

  • The transition between the last owner and the merger between the Priory and PiC company had impacted on staff completing some statutory and mandatory training, including infection control, and life support training. However staff were booked onto training.

Effective

Good

Updated 1 December 2017

We rated Knightsbridge House good because:

  • Agency staff that were unfamiliar with the patients and new starters were given prompt cards to keep on their person. These helped them understand the needs of each patient better. Each treatment card had a ‘recognising side effects’ chart attached, which would guide staff to recognise when patients may be experiencing adverse side effects.

  • Patients had their physical health assessed on admission and an annual health check was carried out thereafter. All patients had care plans that were specific to their needs. There was a ‘this is me’ process in place which captured the individual needs, likes and preferences of each patient.

  • All prescribing was in line with best practice as required by the National Institute for Health and Care Excellence (NICE).
  • The hospital had introduced the Life Star recovery tool. Life star is a tool that aids recovery through the development of positive behaviour plans and interventions that promote independence.
  • Patients had access to a range of professionals including medical and nursing staff, a speech and language therapist (SALT), psychologists and occupational therapists.
  • Staff were being trained in person centred planning. This training was being led by the Priory’s quality improvement leads (QIL’s).
  • ‘Your say’ meetings were held monthly. This meeting was an opportunity for staff to share any concerns or ideas they may have.

  • The use of the Mental Health Act was appropriate and the Mental Health Act (MHA) paperwork accurate and well managed.

  • Patient information relating to the Mental Health Act (MHA) and the Mental Capacity Act (MCA) was available in an easy read format.

However:

  • Supervision levels for staff were low but the hospital were working to address this through the recruitment of more senior staff.

Caring

Outstanding

Updated 1 December 2017

We rated caring as outstanding because:

  • Relationships between staff and patients were positive, warm, respectful and supportive. Patients we met were clearly happy with regards to the care they received and were more than willing to share their experiences with us. There was a strong sense of community spirit within the hospital.
  • There was a strong sense of patient centred care; this was evident in the way staff wrote about how care was planned and provided to patients and our observations of how staff interacted with patients.
  • All staff, including the senior team, were knowledge able about patient’s needs and spoke passionately about wanting to achieve the best possible outcomes for the patients through partnership working and relationship building.
  • The hospital had completed a patient satisfaction survey in May 2017. The results were overwhelmingly positive.
  • Staff that were new or unfamiliar with patients were issued with prompt cards to carry on their person, so that they had information readily available to them when encountering patients around the building. This helped with communication and building relationships.
  • Some patients had voluntarily adopted specific roles within the hospital. Patients had also helped staff risk assess the new hot water machine that was being installed in the hospital.
  • Involvement of patients in the day to day activity of the hospital was actively encouraged. A morning meeting occurred every day where the day and weeks activities would be discussed and organised.
  • Staff worked hard to ensure that patients were included in decisions about their care and treatment. Alternative forms of communication were used where necessary.

Responsive

Good

Updated 1 December 2017

We rated responsive as good because:

  • Knightsbridge house admitted patients from all over the country. However, most admissions were from the surrounding areas.
  • The newly refurbished Solent House will form part of the discharge pathway, creating opportunities for patients to live more independently before discharge into the community, whilst still receiving support form staff at Knightsbridge House.
  • Once admitted bedroom remained allocated to one patient at a time. Patients who took leave, were always able to return to their own bedrooms upon return.
  • All bedrooms were single occupancy with ensuite facilities. Both the main hospital and Solent House were well furnished, clean and comfortable. Patients were able to personalise their bedrooms.
  • The activities room has been adapted to include kitchen facilities which allowed patients to learn new cooking skills.
  • There was a weekly community meeting held for patients. There was a ‘my day’ system in place where patients could choose how they would like to spend one day per week outside of their normal routine and schedule.
  • The hospital aimed to resolve all complaints within 20 working days. Compliance surrounding this was monitored through the governance committee.

Well-led

Good

Updated 1 December 2017

We rated well led as good because:

  • The hospital was well led and well organised. The senior team were a visible presence around the hospital. Staff we spoke with told us that they felt supported by the senior team and the interim ward manager.

  • As a result of the merger, some changes had taken place, including changes to the statutory and mandatory agenda, policies and procedures and the visions and values of the organisation. There were systems in place to monitor the effect any changes to service provision may have on patients and staff.
  • There was a clinical governance committee in place that had oversight of patient safety, infection control, health and safety and security. Key performance indicators (KPI) such as delayed transfers of care were monitored through the governance committee. The hospital had its own risk register which was detailed and up to date. The hospital had set a series of quality improvement objectives for the year. Some of which had been met. There was a company audit plan that was spread over twelve months. This meant each month a specific audit topic would be completed.
  • Morale was high. Staff we spoke with were universally positive about their experiences working within Knightsbridge House. All staff we spoke with told us that they would be able to raise any concerns with senior management without fear of recrimination. Staff appreciated the ‘your say’ forum where they were able to raise any concerns or service ideas they may have.
Checks on specific services

Wards for people with learning disabilities or autism

Good

Updated 1 December 2017