Archived: Maryfield Court

Our rating of this service went down. We rated it as inadequate because we rated two key questions as inadequate (safe and well-led), two as requires improvement (effective and caring) and one key question (responsive) as good. This was because:

• The service did not provide safe care.
• The ward environments were not fully safe, secure and clean. We issued a warning notice to the provider to make sure they improved maintenance and cleanliness of the premises.
• Staff did not always review or manage risk well. Staff did not always update patients’ risk assessments following incidents.
• Managers did not fully identify all ligature risks and did not fully review restraint incidents to ensure they accurately recorded and minimised the use of restrictive practices.
• Staff did not develop individualised holistic, recovery-oriented care plans.
• Staff did not fully record how they actively involved patients and families and carers in care planning and decisions.
• The service was not well led and the governance processes did not ensure that ward procedures ran smoothly. There was too much responsibility placed on one senior manager to manage strategically and operationally this hospital and another of the provider’s hospitals.
• We identified shortfalls not picked up by the provider’s own audits. The provider had not addressed the shortfalls we found on the last inspection. We issued a warning notice to the provider to make sure they improved the governance arrangements.

However:

• Staff provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• The wards had enough nurses and doctors. The ward teams included or had access to a range of specialists required to meet the needs of patients on the wards.
• Managers ensured that staff received supervision and appraisal. The ward staff worked together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness and understood the individual needs of patients.
• The service managed referrals well so that patients were admitted quickly and patients were discharged promptly once their condition warranted this.

We rated Maryfield Court as requires improvement because:

• We found that full physical health screening that included the taking of full histories, on admission, was not completed by staff. Only three patients had had a full history taken and physical examination take place.
• Agency staff when making entries into the electronic care recording system generated the same identification number. Staff should have an individual security pass which identifies their usage of computer systems.
• Information about patients was recorded in different places. New users of the systems would be unclear were to access current information or assessments.
• Staff told us they were unaware that audits of care records were formerly recorded so it was difficult to establish how staff became aware of quality assurance issues.

However:

• The service provided safe care and the ward environment was well maintained, furnished and clean. There were enough staff with the right skills to meet the needs of the patients.

• Patients using the service told us that they were treated with dignity and respect and described the staff as caring and helpful. We observed that staff took time to communicate with patients in a respectful and compassionate manner.

• Regular multidisciplinary meetings were held and attendance by outside agencies was encouraged. Families and carers were involved in this process where appropriate. Advocacy services were accessible and available to support patients.

• The ward environments were effectively managed and risks mitigated with the use of observation. Staff conducted regular environmental quality checks and patients could discuss and resolve environmental issues in community meetings.

• The wards had enough staff on shifts. Patients were supported by a skilled multidisciplinary team of staff which included nursing, psychiatric, psychological and occupational therapy support.

• Staff received supervision and appraisal and worked together as a multidisciplinary team.
• The service maintained good links with other external agencies that formed part of the patient’s care pathway.
• Medicines were appropriately stored, administered and reconciled on all wards. All medicine was in date and labelled.
• Staff were trained in the Mental Health Act and Mental Capacity Act. Staff followed local procedures and support was available from a Mental Health Act administrator. Patients were given information and support to ensure appropriate representation and aid understanding of their rights.
• Staff we spoke with were positive about their roles and were positive about service development. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments.