Ellern Mede Moorgate Also known as Oak Tree Forest Limited

Our rating of this location went down. We rated it as requires improvement because:

• The service did not have enough staff, who knew the children and young people well and received basic training and induction to keep people safe from avoidable harm. The hospital relied on agency staff but did not always ensure they were well trained. One agency member of staff had not received a proper induction and some did not have experience, or training, in working with patients with mental health problems and eating disorders. Some patients had to wait for assistance with personal care or for naso-gastric feeding because staff were too busy supporting other patients.
• Young people did not always get regular time with their named nurse.
• The service did not always have a qualified nurse on shift on both wards at all times.
• Not all clinic rooms were tidy. The clinic room on Aztec ward was cluttered with boxes of equipment on the examination couch. The clinical waste bin did not shut properly. These issues were similar to what we found at our last inspection.
• Care plans did not reflect children and young people's assessed needs, and were not always personalised, holistic and recovery oriented. 4 out of 5 care records we reviewed were not up to date.
• Managers did not make sure that they had staff with the range of skills needed to provide high quality care. They did not support staff with appraisals, supervision and the opportunity to learn via team meetings.
• The service did not plan and manage the discharge of children and young people well as there were no clear plans in place which showed when patients could be expected to be discharged.
• The service was not well-led. A number of issues raised at our last inspection had not been resolved including the clinic room on Aztec ward, agency staff training, and staffing levels.
• Governance processes were not effective, and audits did not always identify areas for improvement. The provider had not recognised several of the issues we found during the inspection.
• The provider had not ensured that staff had access to historical information on the new electronic care records system.
• Despite training being available, staff were not always knowledgeable about how the Mental Capacity Act applied to their work and they could not describe how they worked within the main principles of the Act. Managers did not audit compliance with the Mental Capacity Act.
• Patients did not have open access to outside space because this space was shared with adults which meant that supervision was required.
• Young people told us that although restraint was safe, not all staff carried it out consistently, because some agency staff were trained in different techniques.
• Staff morale was poor. Permanent staff felt over worked, unsupported and unable to take breaks. Some staff had been asked to act up into senior positions without the necessary training and induction. There was a high turnover of staff, and the hospital ward manager posts were vacant

However:

• The wards were safe and clean, well maintained and fit for purpose. Most patients and carers were happy about the quality of the facilities. The food on offer was high quality and varied enough to meet each patient’s preferences.
• Medicines management had improved, and regular physical health monitoring was well embedded, especially for patients with complex needs. Staff followed good practice with respect to safeguarding.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents thoroughly and shared lessons learned with the whole team and the wider service.
• The staff team included a full range of specialists including consultants, doctors, psychologists, an occupational therapist, a speech a language therapist, a dietitian, and a specialist learning disability nurse. The hospital had a lead for autism, senior support workers and activity co-ordinators to support patients in building their skills and confidence.
• Feedback from all the patients and carers we spoke with confirmed that permanent staff treated patients with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved young people and their families in care decisions and kept them informed of significant events.
• Feedback from most of the patients we spoke with confirmed that patients were making good progress towards their recovery goals. The hospital had developed a step-down facility to support patients that were not ready to be discharged but did not require hospitalisation. This was not yet operational when we inspected the service. Staff made adjustments for young people with disabilities and other specific needs. All the patients who required it had a communication passport in place.