The Care Quality Commission
  • Mental Health
  • Independent mental health service

Field House

Overall: Good read more about inspection ratings

Chesterfield Road, Alfreton, Derbyshire, DE55 7DT (01773) 838150

Provided and run by:
Elysium Healthcare (Field House) Limited

All Inspections

21 and 22 June 2021

During a routine inspection

We undertook this comprehensive inspection to look at all key lines of enquiries and the progress made in relation to the warning notices. The hospital was placed into special measures following an inspection in August 2020. We saw in October 2020, that managers had introduced treatment interventions and specialised staff training but this had not been fully embedded. It was evident during this inspection that the new treatment interventions were routinely used to support patients’ rehabilitation.

We saw that the provider had addressed the warning notices issued in September 2020. The service now met all the requirements issued in the warning notices under Section 29 of the Health and Social Care Act 2008.

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

  • The service provided safe care. The ward environments were safe and clean. The hospital had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding
  • Staff developed holistic, recovery oriented care plans informed by comprehensive patient assessments. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. The service worked to a recognised model of mental health rehabilitation. They actively involved patients and families and carers in care decisions
  • Patients’ comments were overwhelmingly positive. A patient told us they were particularly pleased that the service had therapy animals which aided their management of anxiety and reduced incidents of self harm
  • The hospital had access to the full range of specialists required to meet the needs of patients. The manager ensured staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team
  • We saw staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. The service worked to a recognised model of mental health rehabilitation
  • 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
  • Good governance processes were now working effectively at ward level and performance and risk were managed well. The manager has engaged with us through regular engagement and monitoring processes

However:

  • Staff told us they dispensed medication, including those as required from a medicine cabinet in the staff office, situated in the apartments. We noted there was no access to suitable hand washing facilities to enable staff to dispense safely

19 - 20 October 2020

During an inspection looking at part of the service

Overview of the service

Elysium Field House is a specialist long stay rehabilitation service for women with mental illness and a primary diagnosis of personality disorder and/or history of trauma.

Why we did the inspection

The most recent inspection of Elysium Field House was a focussed inspection on 14 August 2020 in response to whistleblowing concerns and other matters of concern. The focussed inspection included specific key lines of enquiry from the safe and well led domains only. Following that inspection, we rated the service inadequate, issued three warning notices and placed the service in special measures. Within a week of completing the inspection in August 2020 we became aware of further new concerns.

We undertook this focussed inspection to look at specific key lines of enquiry in the effective, caring, and responsive domains, and as they applied to the newly raised concerns. We also looked at specific key lines of enquiry relating to safe and well led to look at the progress made in relation to the warning notices. We did not re-rate the service on this occasion and the hospital remains in special measures.

What we found

  • Newly introduced treatment interventions, and specialist staff training had not had time to become embedded practice. Staff had not promoted the healthy eating program and therefore it was not embedded in practice.
  • Labelling of food in the communal fridge was not correct. A staff member told us staff and patients would be advised on correct labelling and given until the weekend to correct this.
  • Portable Appliance Testing had run out in September 2020. Staff thanked us for pointing this out and the manager arranged for an electrician to attend the hospital the next week.
  • Patient and carers interviews, and our review of care plans showed that family and carers were not as involved in treatment planning or service developments as they could be.

However:

  • While staff expressed concern that the apartments would re-open before managers recruited enough substantive and trained staff for the apartments which would impact on patients in the house. Within two weeks of the inspection managers submitted a recruitment plan to support the re-opening of the apartments without detriment to patients in the house.
  • We saw that the provider had addressed the warning notices issued in September 2020. Of the 78 actions identified in the providers action plan to address the three warning notice issues, 64 actions had been completed and implemented; six actions needed more time to achieve completion and eight actions needed more time to become embedded practice. Where actions had not been completed they did have realistic time frames identified.
  • Good governance processes were now working effectively at ward level and performance and risk were managed well. Managers have agreed to engage with us through regular engagement and monitoring processes.
  • The service provided safe care. The ward environments were safe and clean. Managers had closed the apartments to ensure there were enough permanent and skilled staff to meet the needs of patients in the house. Staff assessed and managed risk well, they minimised the use of restrictive practices, and the number of serious incidents had significantly decreased since our inspection in August 2020.
  • Managers review of patient’s acuity and relocation of permanent staff to the house meant that staff could provide a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff told us they now had time to care for patients.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. The service worked to a recognised model of mental health rehabilitation.

What people told us

  • Patients told us that since the apartments had closed and all staff had started to work at the house their care and treatment had improved a lot. Staff had time to talk to them and staff did not cancel therapy sessions because they were short staffed. They also told us there was a good variety of meaningful activity available on the ward and everyone had individual activity programs matched to their goals for getting better. Patients told us the ward seemed much calmer and this helped them to feel safe again.
  • Carers told us they did not feel involved with their relatives or friends care and treatment or discharge planning. Staff had not kept them informed of what was going on at the hospital, they only knew what was reported in local media coverage.
  • Staff told us that not having to cover the apartments and do constant induction and checking in with agency and unknown bank staff they had more time to care for patients. They felt the ward was safer and the number of incidents and restraints had reduced significantly. However, staff also told us they were concerned that if the apartments reopened before managers had recruited and trained enough permanent new staff the current situation would not be sustainable.

14 August 2020

During an inspection looking at part of the service

Field House and Apartments is a specialist service for women with a mental illness.

We have taken enforcement action against the registered provider in relation to concerns about safety in this service. This limits our rating of this service to inadequate. Based on this inspection, the Chief Inspector of Hospitals has recommended that the provider be placed into special measures.

We inspected specific parts of the safe and well led key questions to check that patients were being cared for safely.

We will inspect the service again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

We also served three warning notices under Section 29 of the Health and Social Care Act 2008 against the provider. We told the provider it was failing to comply with the following Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12, Safe care, and treatment. Regulation 18 staffing and Regulation 17 Good governance.

We told the provider it must become compliant with the regulations by 15 October 2020.

We rated Field House as inadequate because:

  • The service did not provide safe care. The care environment was not safe and clean. The service did not have enough nursing staff with sufficient skills and experience to keep patients safe from avoidable harm. Staff did not manage risk well. Following this inspection, we were notified on 1 September of the death of a patient following use of a ligature at Field House on 30 August 2020.
  • Bank and agency staff were not always familiar with the observation policy. The service did not check or monitor that bank and agency staff were completing observations in the correct way or at the correct time.
  • The service did not ensure that mandatory training identified was sufficient to support staff to carry out their role safely and effectively.
  • The service did not have access to the full range of specialists required to meet the needs of patients on the wards. Staff did not have the appropriate skills needed to provide good safe care.

  • The service did not ensure that all staff receive a COVID-19 risk assessment, including a BME COVID-19 risk assessment.
  • The service did not ensure infection control risks were minimised, the unit was not clean and hand sanitiser was not available in the apartments.
  • The manager did not have the skills, knowledge, and experience to perform their roles, or have a good understanding of the services they managed. They were not always visible to patients. Overarching governance was poor.

09 January 2019

During a routine inspection

We rated Field House as requires improvement because:

  • Although Field House was a community based rehabilitation unit, staff had not put a full therapeutic timetable in place for patients.
  • Staff had not completed a systematic audit of ligature points across the whole hospital. There were poor lines of sight to aid staff observations of patients and staff did not follow the policy for completing patient observations.
  • Staff had not recorded the correct form of medication in the controlled drug register and had not completed all health and safety checks in line with the provider’s policy.
  • There were restrictions on patients in place at the hospital. Patients did not have keys to their bedrooms, or other areas that they would be expected to in a community-based rehabilitation unit. Patients were randomly searched when returning from leave.
  • Nurses had not always followed the procedure for administering medication to patients under the Mental Health Act and had not always followed their duty of candour following errors in a patient’s care. This meant a patient was given medication without consent or following the safeguards to ensure it was in their best interest.
  • Families and carers were not involved in planning patient care. Not all patients were happy to raise concerns about their care with staff.
  • The hospital governance structure had failed to identify issues relating to the administration of medication and safety checks. Not all local risks were on the hospital’s risk register.

However:

  • The hospital was clean and tidy and staff had checked emergency equipment and medication in line with the provider’s policy.
  • There was enough staff on duty and all staff had completed their mandatory training. Staff only used physical interventions as a last resort and made safeguarding referrals as needed. Patients had a full assessment of their needs. Staff supported patients to access physical healthcare services and informed them of their rights under the Mental Health Act.
  • There was a fortnightly community meeting for patients to express their view of the service. Staff encouraged patients to help develop their care plans and to access the community. There was an informal complaints log that showed how staff had responded to patients concerns. Staff felt listened to by the manager.
  • The manager had a vision for the hospital and patients and staff had input into the development of the hospital.

6 July 2016

During an inspection looking at part of the service

We carried out an unannounced focused inspection of Field House in response to concerns raised by the registration inspectors following their visit in April 2016. We reviewed the aspects of the service associated with the concerns raised.

We found that:

  • Care plans and risk assessments were detailed and up to date.
  • Staff were readily able to access key documents on the electronic care record system.
  • Staff monitored patients’ physical health regularly and hospital staff had good relationships with other healthcare professionals, including GPs.
  • Staff interactions with patients were warm, genuine and person-centred. Staff treated patients with kindness and dignity.
  • Staff used radios effectively to communicate with each other.
  • Patients were engaged in a range of activities within the community and the hospital environment. Activity planners were individualised and completed in collaboration with the patients.
  • Staff spoke positively about the leadership within the organisation. There were plans in place to manage the recruitment process for a new registered manager.
  • Staff felt supported in their role and had good access to specialist training where necessary.
  • Field House had a robust admission process that carefully considered the mix of patients and skill set of staff.
  • All staff had completed their mandatory training, which included The Mental Health Act (MHA) and The Mental Capacity Act (MCA).
  • Patients had access to an Independent Mental Health Advocate (IMHA).

However:

  • Not all staff could recall whether they had completed training in Mental Health Act or Mental Capacity Act.
  • No patients were allowed unsupervised access to the small kitchen. There had been no risk assessment completed for this decision.
  • Not all patients were given copies of their ‘personal planning books’ to keep in their bedrooms. There was no evidence to support the reason behind this restriction.
  • There was no Independent Mental Capacity Advocate available to patients (IMCA).

1 October 2015

During a routine inspection

We rated Field House as good because:

  • it provided a homely environment that promoted the safety and wellbeing of patients
  • patients’ bedrooms were personalised to reflect the taste and preference of individual patients
  • staff supported and encouraged friends and relatives to be involved in their relatives’ care
  • the Department of Health “Positive and Safe” (2014) programme had been adopted and implemented, nursing staff carried out regular physical health monitoring, and set out any identified physical health needs in detailed care plans
  • patients were registered with a local GP and were able to be seen by the GP at the local surgery or at Field House
  • patients had access to a speech and language therapist (SALT) who assessed needs and planned care accordingly
  • the cook ensured that all patients’ dietary needs were met, and nursing staff provided any support required for eating and drinking safely
  • the multidisciplinary team (MDT) assessed actual or potential risks using recognised risk assessment tools
  • staff measured patients’ progress using a recognised outcome measure called the health of the nation outcome score for learning disability (HoNOS LD)
  • patients received input from a psychologist who helped them with any communication difficulties and contributed to the multidisciplinary team (MDT)
  • medicines were managed safely
  • managers supported and encouraged staff to attend specialist training relevant to the patient group
  • staffing levels were safe and the use of temporary staff was low
  • staff raised safeguarding alerts appropriately, knew how to record and report any risk incidents or near misses, and there was evidence of learning lessons from incidents
  • patients had regular access to an independent mental health advocate (IMHA).

However:

  • Mental Health Act documentation was not always accurate, and Mental Capacity Act documentation did not always contain sufficient detail
  • it could sometimes be difficult to access specific key information quickly because the care record system was in the process of transition from paper records to an electronic record system
  • ligature risks were not recorded on the risk register
  • the narrow corridors made it difficult for wheelchair users to navigate independently.
  • the narrow corridors could not accommodate three people walking abreast in the event of a patient being re-located under physical restraint
  • psychiatric cover consisted of attendance at the fortnightly multidisciplinary team (MDT) meetings, and on-call or telephone cover at all other times.

12 November 2013

During a routine inspection

There were 7 people receiving care and treatment at the time of this review. During our visit we spoke with the manager, 3 staff and one person receiving care. Some people were not able to tell us about their experience of the hospital.

We saw interacting positively and patiently with people. One person told us about their interests and how they liked to go out with staff.

There were suitable arrangements in place to ensure that people were consulted and involved in making decisions about their care. Where people could not make decisions there were systems in place to ensure decisions were being made in people's best interests.

We found that people experienced care and support that mostly met their needs and protected their rights. People had regular access to advocates and were informed of their rights.

The environment of the home was maintained to a comfortable standard and people's bedrooms were individual reflecting their tastes. However actions have not yet been taken to respond to the findings of the fire officer's report from July 2013.

Suitable pre-recruitment checks were made before staff commenced in post. However there was a fragmented decision making process in place as regards offering employment to staff.

4 October 2012

During a routine inspection

Some people in the home had limited communication abilities and so we could not interview them to find out their views. However, we were able to observe their mood and behaviour and how they interacted with staff. We spoke with the manager, three staff members, two people who used the service and two relatives.

People and their relatives told us they were involved in making decisions about their care. The care plans were signed by people, or their relatives, to show their involvement and agreement.

We found that whilst there were systems in place to ensure that most of people's healthcare needs were being met there was no provision to provide speech and language therapy (SALT) to people. As this was an identified need for some people due to communication and swallowing difficulties this could place them at risk.

Relatives told us that staff were 'Nice and kind' to people, another relative told service user staff were 'Very good'. People knew who their key workers were and said that staff did 'sit and talk' to them regularly.

There were systems in place to monitor the quality of the service as meetings and surveys were regularly conducted. This ensured people, their relatives and staff could share their views about the service.

21 November 2011

During a themed inspection looking at Learning Disability Services

There were eight people living at Field House when we visited. We met all of the people living at Field House throughout our two day inspection visit. The majority of people were able to verbally communicate with us. However the level of people's communication skills was limited.

People were very welcoming to us and some people were keen to show us their bedrooms. Due to people's communication skills they were unable to talk to us in detail about the service they received. Overall the staff appeared very friendly however staff tended to speak for people or prompted people to answer. Some people were able to confirm that they were supported by staff and told us about some of the activities they had done. People confirmed that they liked living at Field House.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.