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We are carrying out checks at Broomhill using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 4 to 6 and 21 December 2017

During a routine inspection

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 carried out on 22 to 24 March 2016

During an inspection to make sure that the improvements required had been made

We rated Broomhill as requires improvement because:

  • The service had several ligature risks, many of them in bedrooms and bathrooms. Staff had not conducted a ligature risk assessment to assist in mitigating these risks.
  • The clinic had a defibrillator, however no emergency drugs or oxygen cylinders were available.
  • All medication apart from Clozaril came from a local pharmacy. Prescribing was undertaken by the local general practitioner (GP) and not the responsible clinician.
  • There was no evidence of learning from incidents or complaints being fed back to the staff.
  • Despite having a structured activity programme, staff did not provide any psychological therapies to benefit the patient group.
  • Staff did not use any recognised outcome tools to measure patient progress.
  • Staff audited Mental Health Act compliance. No other clinical audits were undertaken.
  • Three T3 forms (certificates of second opinion) did not have the correct hospital address on them.
  • We interviewed four patients who all stated they had copies of their care plans but only two stated they were involved in developing them.
  • Of the entire staffing at Broomhill only 66% had received an appraisal, whilst supervision records showed only 44% of staff had received supervision in August/ September 2015.
  • Only 66% of staff had completed all the mandatory training.
  • Only one qualified staff member worked at weekends at night. This raised concerns about patient safety if there was an incident and staff working long hours without a break.
  • The service did not have a risk register, meaning the management team did not robustly manage potential risks to the service.

However:

  • Staff undertook patient risk assessments upon admission and recorded these in their notes. Weekly ward round notes show that risk assessments were updated regularly.
  • Staff read patients their rights every three months and the mental health act administrator recorded this. Mental Health Act section papers were appropriately stored and in date.
  • Staff treated patients with kindness and respect. We saw that staff understood individual needs and were aware of patients’ preferences.
  • Patients were able to choose their own diet to meet their needs either by going out shopping or accessing the menu at Broomhill.
  • Staff were aware of the senior managers who visited the unit regularly, and staff spoke highly of the manager at Broomhill.

Inspection carried out on 8 August 2013

During a routine inspection

We spoke to nine out of 15 patients at Broomhill. We also spoke to the registered manager and several staff who were supporting them and we observed how support was provided.

Patients also told us that they were generally satisfied and involved with the care, treatment and support they received from staff. They said that there were plenty of activities to do. For example this included doing group activities such as gardening, baking, keep fit, board games, anger management, read papers, and go out in the community. One person told us “I do my own laundry and clean my room” and “I also cook once or twice a week” and they told us that they enjoyed this. Another person told us that they looked after the chickens, collected the egg and helped sale them. They told us that they enjoyed doing this activity.

All the patients also told us that they knew how to make a complaint if they were not happy with the quality of service received. They told us that they were encouraged to express their views at their monthly “community” meetings and felt they were listened to by staff. The patients also told us that most of the staff were nice and had been on training courses to look after them. They also said that they were given support to learn new skills to become more independent.

Inspection carried out on 6 September 2012

During a routine inspection

During the inspection we spoke with six people who used the service. We were also accompanied by a member of Mental Health Act Operations.

One person told us “I do like it here” this was because they said that the views of the countryside were lovely and relaxing. They also told us that the staff spoke to them in a kind manner and “treats me with respect”. Another person said “I do my own laundry and dry it”. They told us that they had a family and “two staff take me to visit my family” and they enjoyed this.

All the people we spoke with told us that the place was well decorated, and clean. One person told us “I have a nice large room with a double bed and I have my own toilet and shower room” and they were happy with this. They told us that they helped look after the chickens and watered the plants. All the people told us that the food was “very nice” and they had three choices of meals. One person told us “the vegetarian food is not bad and I don’t eat meat”.

People we spoke with told us that they were involved in planning their care. They told us that they knew about care plans because the care staff talked to them about this. They said they were given information about how to make a complaint if they were not happy with the service. One person told us that they spoke to the advocacy service and they told us that this information was displayed on the notice board.

Some people told us that the qualified nurses explained and gave them information about their rights. This was so they understood their responsibilities of living at the service. Most people told us that the staff were kind and respected their privacy and dignity. They said the staff knocked on their doors before they entered their rooms.