Ivetsey Bank Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as Requires improvement. The service was in breach of legal regulation in relation to Regulation 12 of the Health and Social Care Act, Regulations 2014 Safe care and treatment. Staff were not always bare below the elbows, in line with infection prevention and control guidelines. The service had made improvements and is no longer in breach of regulations.

At this assessment the rating has changed to Good.

Good: This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

Staff knew what incidents to report and how to report them. The hospital followed their own internal policy on reporting incidents and escalating concerns. We reviewed 10 incident reports. These showed that staff had taken appropriate action in relation to reporting incidents. While most records were completed fully and accurately, one record did not reflect actual events. This was picked up by management during their audit, rectified and an investigation opened.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong.

Managers investigated incidents thoroughly and supported staff following incidents through debriefs and reflective practice. Staff told us that debriefs took place after serious incidents and that leaders had an open-door policy for any concerns following incidents.

Staff received feedback from the investigation of incidents, both internal and external to the service. We saw evidence that incidents were discussed in staff and governance meetings, and also during handovers between shifts. Staff were able to provide examples of learning following incidents and how this was implemented across the service. For example, the managers completed random spot checks at night

Staff met to discuss the feedback and how improvements could be made to the service and patient care. Individual incidents were discussed during daily handover and weekly multidisciplinary huddle meetings. There was evidence that changes had been made as a result of feedback.

Managers shared learning with their staff about serious and never events that happened elsewhere. Learning from other services was also shared in meeting and cascaded across the team.

At the last inspection, we found that staff were not always adhering to infection control practices and were not always bare below the elbow. This had improved and we found that staff on the wards were bare below the elbow.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

The service had a clear admission criteria and managers told us they would only accept referrals if the service could meet their needs. Managers said they felt supported by the senior leadership team in making these judgements.

The service’s referral and admission processed ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Staff had supported patients prior to and during the transition of services and renovations around the hospital.

At the time of the inspection, only two of the three existing wards were open due to the renovation works taking place. There were 8 patients admitted to Wedgwood ward, the eating disorder unit, and 7 patients on Thorneycroft ward, the general admissions unit. There was also one patient in the extra care area being nursed on enhanced observations.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

Staff received training on how to recognise and report abuse, as appropriate for their role. Staff kept up to date with their safeguarding training. They were 100 per cent compliant in their mandatory safeguarding training.

Staff knew how to make a safeguarding alert and did that when appropriate. Staff we spoke with had a good understanding of about safeguarding and any potential concerns were discussed during handovers, clinical governance and multidisciplinary huddles and patient reviews.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. There was a dedicated safeguarding lead in the hospital who staff could approach for support.

The hospital director informed us that they had a good relationship with local safeguarding authorities and had regular engagement with them.

Staff followed safe procedures for children visiting the service. Siblings were supported to attend and visit when accompanied by an adult, and a visiting room was available.

Staff explained the safeguarding procedures to patients on admission and patients had access to the relevant information through notice boards and an information pack.

The hospital closely monitored the use of restraint and restrictive interventions and worked closely with staff to ensure they were appropriately trained and up to date with relevant practice and policy. The service had changed the method they used for restraints around five months prior to the inspection. Staff told us that in the first couple of months, it took a while to get used to the new methods of applying holds and they had raised the need for extra support. In response, the hospital had ensured that there was a trainer available on every shift who could intervene and support staff while they got used to the new techniques. Staff informed us that they felt well supported through the change and that in recent weeks, most staff had started feeling comfortable with the change in technique and there were fewer occasions where they required additional support.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

We reviewed 10 electronic care records. Staff completed risk assessments on admission, during ward rounds and updated them following any incidents. Staff discussed incidents during handovers, multidisciplinary ward rounds and huddle meetings.

Most patients felt involved in and understand their risks and how they were supported to keep themselves safe. Most patients had personalised plans in their rooms and on their doors on how they wished to be supported. Staff involved patients in care planning and risk assessment as demonstrated by their input in care plans, participation in multidisciplinary team reviews and access to their care plan copies.

Staff told us they were committed to reducing restrictive practices. The provider had recently changed their restrictive interventions approach to one that prioritises de-escalation techniques. The provider changed this as part of their reducing restrictive interventions scheme, and trained all staff in the new approach, and put support in place during the transition period.

Staff told us they made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep patients or others safe. A number of patients had specific care plans designed for using restraint where this was necessary for the use of nasogastric (NG) feeding tubes.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. For example, staff used visual cue cards and positive behavioural plans to support patients in understanding their care and treatment.

Staff enabled patients to give feedback on the service they received. For example, patients could give feedback by talking with staff, completing feedback forms and during community meetings.

Staff ensured that patients could access advocacy.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Description: We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

We looked at the staffing figures for the service. At the time of the inspection, there was a surplus of staffing in the service due to the closure of two of the wards across the hospital. These wards were closed for refurbishing and redesigning of the service pathway. There were no vacancies at the time of the inspection.

Managers had calculated the number and grade of nurses and healthcare assistants required. The staffing establishment levels depended on the ward requirements, number of patients and any additional observations that were taking place on each ward. At the time of the inspection, there was no shortage of staff and each shift was filled to establishment and more.

Ward managers felt they could adjust the staffing levels to take account of acuity levels on the wards. When necessary, ward managers could deploy bank staff to maintain safe staffing levels. All staff, including bank, received an induction to the wards and were familiar with the wards.

During our inspection, we observed that there were always staff present in the communal areas of the ward at all times. Due to the surplus in staffing numbers, the staffing numbers were more than each ward required, but the hospital director had a rationale for this, as these staff would be deployed to other wards once the refurbishments had been completed.

At the time of the inspection, staff told us there were always enough staff around to facilitate patient leave, ward activities and to carry out physical interventions safely.

There was adequate medical cover day and night and a doctor could attend the ward quickly in an emergency.

Staff had received and were up to date with appropriate mandatory training. At the time of the inspection overall mandatory compliance was at 96%.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.