Nightingale Hospital

Updated 10 October 2022

Nightingale Hospital is an independent hospital that provides mental health care and treatment for people who may or may not be detained under the Mental Health Act 1983. The hospital offers general psychiatry, eating disorders, obsessive compulsive disorder and addiction treatment for adults as both inpatients and outpatients.

The service provides three acute wards for adults of working age, one obsessive compulsive disorder ward, a substance misuse and detoxification ward, and a specialist eating disorder service for adults. Wards provide mixed sex accommodation, apart from two acute wards on the first and second floors, that are single sex. The ground floor ward was a mixed sex 11 bed acute ward for adults of working age. The first floor had two wards: a 14 bed male acute ward and a six-bed obsessive compulsive ward for adults of working age. The second floor was a 17 bed female only acute ward for adults of working age. The eating disorder ward was located in a separate nine-bedded three-storey building. The eating disorder unit also accepted day patients.

The service has 73 beds across general mental health, addictions, and eating disorder treatment wards. At the time of our visit, there were 42 patients admitted to the hospital over six wards, with six patients on the eating disorder ward, three patients on the substance misuse ward and 34 patients on the general acute wards.

There are over 60 consultant psychiatrists who have been granted practising privileges at the Nightingale Hospital. This means that they can admit patients they see in the community to an inpatient bed and remain their consultant while the patients are on the ward.

The service is registered to provide the following regulated activities: treatment of disorder disease or injury; diagnostic and screening procedures; and assessment or medical treatment of person admitted under mental health act and nursing care. There was a registered manager in place at the time of the inspection.

We last inspected the Nightingale Hospital in March 2019. The overall rating was good. The hospital had made significant improvement after an inspection in January 2018 that had an overall rating of requires improvement. The acute wards for adults of working age and psychiatric intensive care units had requiring improvement rating in safe and good in effective, caring, responsive and well led. The specialist eating disorder ward and substance misuse ward was rated good overall, and good in safe, effective, caring, responsive and well led.

As this inspection took place during the Covid-19 pandemic we adapted our approach to minimise the risk of transmission to clients, staff and our inspection team. This meant that we limited the amount of time we spent in the service to prevent cross infection. Whilst on site we wore the appropriate personal protective equipment and followed local infection control procedures. We carried out some staff interviews via video, as well as analysis of evidence and documents. Our final video call interview was completed on 17 June 2022.

Updated 10 October 2022

We rated acute wards for adults of working age and specialist eating disorder wards as requires improvement overall. We rated the substance misuse ward as good overall.

We rated Nightingale Hospital as requires improvement because:

• Staff completed ligature risk assessments for wards, but these were missing important details, confusing and lacked clear plans in place to mitigate risks identified. Some staff we spoke with did not know how to find the risk assessment.
• Staff developed care plans but did not always reflect patient risks, needs and goals on the acute and eating disorder wards. We found that staff reviewed care plans on a regular basis but there was no evidence that these reviews were meaningful in terms of making appropriate changes in line with patients’ current presentation. Care plans for day patients in eating disorder had not been reviewed after they were discharged from the ward, so were not an up to date reflection of their care.
• The service had systems and processes in place to provide assurance and deliver the organisation’s services safely, but these were not always effective. We found areas for improvement in their governance processes. Although performance data was collected, there was limited evidence of improvements. For example, the quality of some essential patient records were still not adequate and could lead to unsafe care and treatment.
• The service had not documented a specific risk assessment for a patient under 18 years old admitted to an adult ward, including consideration of risk related to their age and vulnerability.
• Staff did not use a recognised risk assessment for patients in terms of their tissue viability (to monitor their risk of developing pressure ulcers) on the eating disorders ward and the ward did not have a safe and appropriate chair for patients who needed feeding by naso-gastric tubing.
• Patients in eating disorder ward described some variability in the way different staff treated them, with some staff not understanding their individual needs, and not treating them with compassion and kindness and respecting their privacy and dignity.
• Although records showed that staff checked emergency equipment weekly some of it had expired, removed from the emergency kit and not been replaced. A defibrillator was noted to have had a low battery since May 2022. It was not clear from the paperwork or from talking to staff how this identified issue had been actioned.
• Some prescription charts on the acute wards did not record the name of the patient or the name of the prescriber, which meant there was a risk of patients being given the incorrect medicines.
• Staff did not always document discharge plans or approximate dates of discharge for all the care records we reviewed on the acute, obsessive compulsive ward and eating disorder wards. It was difficult to ascertain whether these discussions had happened with the patients by looking at their records.
• The overall vacancy rate at the hospital for clinical staff was 29%. The hospital had used long term contracts with bank and agency staff to fill these roles. Staff vacancies had been filled with long term locum staff. This had the potential to affect continuity of patient care.
• The service was not smoke-free in line with best practice.
• The services used closed circuit television (CCTV) in all communal areas but did not have signs to make people aware of the use of CCTV. We raised this with the staff who promptly added the signs.
• Female patients on the substance misuse service mixed sex ward did not have access to a female only lounge.
• The provider had not developed staff competencies for key tasks specific to treating patients with eating disorders and autism.
• Clinic room temperatures in the substance misuse ward were above 25 degrees, which is above the recommended temperature for the storage of medicines.

However:

• Staff in substance misuse service, acute wards and obsessive compulsive disorder wards treated people with compassion and kindness and understood their individual needs.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team.
• The daily handover sheets were very informative and had key patient information that staff reported to be useful.
• Patients on acute and substance misuse wards felt that nurses were responsive, any issues raised are promptly addressed and patients enjoyed therapy groups.
• All records we reviewed in the substance misuse ward included a comprehensive assessment of patients’ drug and/or alcohol dependence level, healthcare and other needs.
• The substance misuse ward met the needs of all patients – including those with a protected characteristic. The ward had recently held an LGBT+ event on the ward, where advice and information about services that support the LGBT+ community was shared.

Updated 10 October 2022

The eating disorder ward was located in a separate nine-bedded three-storey building. The eating disorder unit also accepted day patients.

Updated 10 October 2022

The substance misuse service a 28-day treatment programme or a detoxification programme. The therapy programme followed the 12 step programme, a widely used and recognised psychosocial treatment programme for people with addictions.

Updated 13 May 2019

The hospital had taken action to address areas highlighted as a concern in the last inspection in January 2018. This included taking steps to address environmental risks, with significant work undertaken to reduce ligature risk areas on each ward, personal alarms provided to staff, improved infection control protocols, and addressing actions from the hospital’s fire safety assessment.

The provider put in place systems to ensure that staff were made aware of lessons learned from incidents, and staff had regular supervision and appraisals.

Staff had received training in interventions to protect patients from harm, including the provision and use of naloxone, and action to take in the event of an alcohol withdrawal seizure. Staff understood how to use the validated tools for patients undergoing detoxification from prescribed drugs and alcohol. There were also improved protocols for ensuring that patients undergoing detoxification were protected from harm, including better physical health monitoring.

Improvements were made to the prescription, storage and administration of medicines.

There was an improvement in recording patients’ involvement in the development of their care plans.

However:

Staff did not have access to the results of recent audits on the wards, and there were no regular checks of mattresses and soft furnishings on the wards to ensure good standards of infection prevention and control.

Nursing competencies for the addiction unit staff were not specific to the care of patients with substance misuse issues.

Staff meetings were not always held on a regular basis or include standard agenda items related to quality and safety. Staff were not always able to access a clear record of the minutes of the last meeting.

Updated 10 October 2022

The acute wards provided mixed sex accommodation, apart from two acute wards on the first and second floors, that are single sex. The ground floor ward was a mixed sex 11 bed acute ward for adults of working age. The first floor had two wards: a 14 bed male acute ward and a six-bed obsessive compulsive ward for adults of working age. The second floor was a 17 bed female only acute ward for adults of working age.