Forest Hospital

Updated 11 December 2019

Forest Hospital, owned by Barchester Healthcare, is a 30-bed mental health independent hospital designed to provide accommodation, rehabilitation, personalised care and support for men and women over the age of 18. The hospital is set in large grounds with gardens, in a residential area and is served by a local bus service.

Forest Hospital was previously a longer-term high dependency rehabilitation unit. However, since our last inspection the hospital had changed its model of care and was no longer working with patients who required active rehabilitation. The hospital did not consider itself to be a formal rehabilitation setting. Staff worked with patients to improve the quality of their life and to support them to manage behaviour that challenged so that they could eventually be stepped down in to a less restrictive environment. The patients required a complex model of care. More than half of the patients could not carry activities of daily living without support.

Forest Hospital is registered with the CQC to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder or injury.

Patients cared for at Forest Hospital:

• May be detained under the Mental Health Act (1983) sections 2,3,37 and 41 or informal.
• May be detained under Deprivation of Liberty Safeguards, which is part of the Mental Capacity Act
• (2005).
• Have a primary diagnosis of mental illness with complex needs.
• Typical diagnoses include dementia, Parkinson’s, Huntington’s Disease, Korsakoff's and Depression.

May be treatment resistant.

There are two single sex wards called Horsfall (female) and Maltby (male).

At the time of inspection, there were 13 patients in the hospital There were no informal patients. Six patients were detained under the Mental Health Act, five were subject to Deprivation of Liberty Safeguarding and a further two patients were waiting for Deprivation of Liberty Safeguarding. The hospital opened in 2013.

The hospital had appointed a new hospital director, who was the registered manager. They had started in their role in February 2019. There had been a period of leadership instability prior to the new hospital director’s appointment.

There have been eight inspections at Forest Hospital since registration with CQC; the last comprehensive inspection took place in October 2018. We rated the hospital as requires improvement over all; rated safe as requires improvement, effective as requires improvement, caring as good, responsive as requires improvement and well-led as inadequate. We made recommendations about what the provider must do to improve. We told the provider to improve their governance systems in relation to carrying out audits, safe observation practices, care records and patient activities. We also told the provider they must improve the way that they completed support plans, checked emergency equipment and monitored physical health. We also told the provider that they should make improvements in additional areas.

The most recent Mental Health Act review visit took place in July 2019. At this review we saw that patients on Maltby ward did not have access to the garden, as the door was locked. This blanket restriction had not been assessed and documented for individual patients. Also staff did not always document when they had informed patients of their rights under the Mental Health Act.

Updated 11 December 2019

Our rating of this service improved . We rated it as good because:

• The service provided safe care for patients with neurological mental health conditions. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• Staff developed holistic care plans. They provided a range of treatments suitable to the needs of the patients cared for and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well 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, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

However:

• When staff carried out observations they continued to use pre-printed record sheets which meant they did not record an accurate time for their observation.
• Staff did not consistently monitor patient’s physical health as they should have done, record their actions and did not always act when patients’ physical health had deteriorated. We saw that cupboards on Maltby ward where medicines were stored were not clean. Staff had used out of date medical supplies and had not acted when the fridge temperature had increased above safe levels.
• Although some activities were taking place, which was an improvement from our last inspection, staff did not always accurately record whether patients were engaged in therapeutic activities.

Updated 11 December 2019