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Inspection Summary


Overall summary & rating

Good

Updated 7 February 2018

We rated Broomhill as good because:

  • Patients reported feeling safe on the wards.
  • Six of the seven wards were clean, tidy, and well maintained.
  • Staff demonstrated the provider’s visions and values in their behaviours.
  • We observed staff to be passionate and motivated to meet the patients’ care needs.
  • Staff demonstrated a good understanding of patients’ individual needs, including care plans, levels of observations and risks.
  • Staff completed assessments for all patients following admission.
  • The Mental Health Act administrators had good oversight of the service and provided support to the wards.
  • Shift to shift handovers were taking place daily.
  • Senior managers had good oversight of the wards and clinical governance. There was a robust process in place to drive up standards and compliance.
  • Staff consistently reported that managers were supportive and would listen to concerns.
  • Staff morale was good and teams were striving to provide good care and treatment to patients. Managers were responsive in making improvements.

However:

  • The management of medication, specifically stock control was not robust across all wards. Not all medical equipment was in date or checked regularly.
  • Ligature risk assessments did not cover the hospital communal areas. The ward assessments were not robust.
  • Not all staff had personal alarms and there were areas across all wards where there was no immediate access to an alarm point.
  • The service employed four health care assistants that were under the age of 18 and legally a child. There were no additional risk assessments, support, or supervision in place for these staff.
  • Overall, compliance with mandatory training was poor at 51% between April and November 2017. Not all staff received regular supervision and compliance for appraisal was low.
  • Capacity assessments were present but not always detailed; they did not document rational for decision making.
  • Care plans were not always holistic or recovery focused. They did not routinely capture the patient’s views or identify strengths.
  • Some staff did not receive feedback from investigations or were aware of lessons learnt across the service.
  • Regular ward team meetings were not taking place and attendance at the service wide staff meeting was low.
Inspection areas

Safe

Requires improvement

Updated 7 February 2018

We rated safe as requires improvement because:

  • Ligature risk assessments had not been completed for the hospital communal areas. Ward ligature risk assessments were not robust.

  • Not all staff had personal alarms and there were areas across all wards where there was no immediate access to an alarm point.

  • Overall, compliance with mandatory training was low at 51% between April and November 2017.

  • The process for checking medication was not robust.

  • Staff did not maintain all areas of the Manor ward to a good standard.

  • The service employed four health care assistants that were under the age of 18. There were no additional risk assessments, support, or supervision in place to support these staff.

  • Managers shared lessons learned, but not all staff were aware of what they were.

  • There were blanket restrictions in place for patients accessing fresh air.

  • We found out of date medical equipment across the service.

However:

  • The wards had sufficient staff to provide care and treatment to patients.

  • Six of the seven wards were clean, tidy, and well maintained.

  • All wards had fully equipped clinic rooms with accessible resuscitation equipment and emergency drugs across the service.

  • Staff undertook a risk assessment with every patient upon admission.

  • Cleaning records were up to date and demonstrated that staff regularly cleaned the environment.

  • Patients reported feeling safe on the wards.

  • Staff sickness was low at less than 1%.

  • Overall, 81 % of staff had completed safeguarding adults training.

  • There was a robust process in place for reporting and documenting incidents and all staff were aware of this.

Effective

Good

Updated 7 February 2018

We rated effective as good because:

  • Staff completed comprehensive assessments for all patients following admission.

  • There was a robust provision for the ongoing monitoring of physical health.

  • There was assessment of nutrition and hydration and care plans were in place for specific patients.

  • Managers addressed poor staff performance promptly.

  • The provider carried out regular audits to ensure that the Mental Health Act was applied correctly.

  • Staff demonstrated an understanding of the Mental Health Act and Mental Capacity Act.

  • Capacity assessments were in place where required.

However:

  • Capacity assessments did not always document the rational for decision-making.

  • Not all staff received regular supervision and compliance with appraisal was low.

Caring

Good

Updated 7 February 2018

We rated caring as good because:

  • Patients reported that they were cared for and treated with respect.

  • Staff were positive, supportive, and caring in their interactions with patient and patient’s confirmed this.

  • We observed staff to be passionate and motivated to meet the patients’ care needs.

  • Staff supported patients to develop and maintain social networks. Families could visit and attend reviews.

  • Staff demonstrated a good understanding of patient’s individual needs, including care plans, observation levels, and risks.

  • Advocacy support was available to all patients.

  • Advance decisions were in place where appropriate.

However:

  • The quality of care plans varied across the service. Care plans were not always holistic or recovery focused and they did not routinely capture the patient’s views or identify strengths.

Responsive

Good

Updated 7 February 2018

We rated responsive as good because:

  • The wards were appropriate for the service being delivered with a range of equipment to support treatment and care.

  • There were appropriate spaces for visiting within the service.

  • There were activities across the week.

  • There was a range of information leaflets available for patients.

  • There was appropriate access to spiritual support.

  • Patients had access to drinks and snacks throughout the day.

  • Patients could personalise their bedrooms should they wish to.

  • Patients knew how to complain and staff would support them with this. Each ward had comments boxes that patients could use.

However:

  • Some patients were unhappy with the variety of meals available to them.

  • There were limited rooms available for staff to have individual sessions with patients in confidential areas.

  • Not all wards had direct access to an outdoor space. This limited opportunities to access fresh air.

Well-led

Good

Updated 7 February 2018

We rated well-led as good because:

  • Senior managers had good oversight of clinical governance and were monitoring issues on the risk register.

  • Staff morale was high and staff were motivated and felt supported by managers.

  • Staff described managers as visible and approachable.

  • There were sufficient staffing in place to ensure that patients’ needs were met.

  • We found teams were cohesive and supportive of one another.

However:

  • Compliance with mandatory training was low and not all staff had received the required training prior to working on the wards.

  • Supervision and appraisal compliance was low; however, the provider had a plan in place to address this.

  • Not all staff were aware of lessons learnt or received feedback from investigations.

  • Regular staff team meetings were not taking place and attendance at the service wide staff meeting was low.

  • Not all staff were aligned to a specific ward and this affected consistency of care.

  • The provider did not follow their policy to monitor the fitness of directors of St Matthew’s Healthcare Ltd

Checks on specific services

Long stay/rehabilitation mental health wards for working age adults

Good

Updated 7 February 2018