Field House

On this page

• 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 requires improvement. At this assessment, the rating has changed to Good. This meant people were safe and protected from avoidable harm.

The service provided care and treatment in a way which made patients feel safe, supported, involved and listened to. Patients felt they were treated with kindness, compassion, dignity, and respect. They were treated as individuals and encouraged to be involved in their care and treatment planning. Staffing, processes, and equipment were in place to maintain the safety of the patient and to meet their needs. Staff engaged with patients in a kind, compassionate, and caring way. The environment, and equipment was clean, tidy, and well maintained. Information regarding the patients care, treatment, and external resources available were displayed around the service.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had effective systems and processes to allow the recording of incidents, and we saw evidence of effective learning from when things went wrong. Concerns were appropriately recorded by staff at all levels, and leader's investigated concerns and shared outcomes with all involved in a transparent way. Staff learnt from safety incidents, and had debrief meetings with peers and management. Incidents were discussed with people who use the service and in multidisciplinary meetings (MDTs) to ensure lessons were learnt and shared. Staff knew the process of reporting incidents. They were supported to raise concerns and felt confident in doing so. Staff felt that incidents were investigated thoroughly. One staff member told us “We learn from every incident, we have a debrief, for example following the use of restraint. If we can do something better, or if we made a mistake, we apologise”.The service used the learning from complaints and concerns as an opportunity for improvement. Managers would share the learning from complaints and concerns with the staff to improve their clinical practice and outcomes for patients. Information was displayed around the service on how people were able to give feedback on their care or raise a complaint. This evidenced the learning culture of the service.

Patients, and all the people involved in their care were included in decision making around their care and treatment when transferring to a different care setting. Staff told us about examples of successful discharges, for example when people moved on to live in the community. Staff worked well with external partners, for example social workers. One staff member told us, “I have seen many successful discharges in my 2 years of working here, where people had moved on to live in the community. It is a very happy outcome to see. This is what motivates me to come to work”. Staff at the service and external partners worked well together, enhancing the quality of care for people using the service, whilst maintaining continuity. Feedback from partners highlighted that the service worked well with them when planning the admission or referrals to other services, and when planning the discharge of patients.

Patients felt safe, supported, and did not raise any safeguarding concerns during this assessment. Staff understood safeguarding and knew how to report their concerns. they were able to identify different forms of abuse and what actions they would take to safeguard patients. They were confident in escalating concerns and making referrals to the local authority. Safeguarding information was displayed on patient information boards throughout the service.Daily patient safety and safeguarding meetings were held to ensure any safeguarding incidents were addressed. A clear process was in place for raising safeguarding concerns. The provider worked collaboratively with the local authority safeguarding team and the Care Quality Commission (CQC) to discuss progress and outcomes of investigations.

Staff involved patients in managing individual risks, risk assessments were person-centred, proportionate and reviewed regularly. Positive risk taking was promoted, where possible to support people’s independence, for example, reviewing patients' observation levels to facilitate escorted/unescorted leave. Staff used restrictive interventions to maintain the safety of patients, if required. Staff were trained in de-escalation techniques and knew what techniques worked for individual patients. All staff were aware that restraint should only ever be used as a last resort. One staff member told us, “We carry out patient observations in line with their care plans, and we always have personal alarms to hand in case of emergency. When we activate the alarm, other staff come to support quickly”. Most risk assessments we reviewed were informative and up to date. However, we identified one care plan that did not clearly identify all risks for a person. While staff were aware of the risks, there was no clear guidance in place about how to support the person, for example with their medication. This potentially placed the person at increased risk of harm. We discussed our concerns with the service who immediately rectified this, implemented an action plan, and provided the required assurances before we concluded the assessment.

Processes were in place to maintain the environment; these were reviewed regularly and highlighted any risks with the appropriate mitigations in place. A ligature risk assessment was in place and audited regularly, cleaning audits were completed, any issues found were resolved. The environment was clean and safe. There were enough rooms and an outdoor space where people could spend time on their own or socialise with others. Staff carried out regular environment and equipment audits to maintain safety. Nurse call systems were in patient bedrooms to support their safety and could be used by patients, and staff if support was required. Staff had personal alarms which could be used if assistance was required to maintain patients' safety. CCTV was in operation throughout the service. All bedrooms had an en-suite shower and toilet. Bathrooms were also situated around the ward. Rooms were available for multi-disciplinary team (MDT) reviews. There were therapy rooms for psychology and occupational therapy sessions, and assessments. There was a well-equipped sensory room, The dining room was clean and had enough seating to allow patients and staff to have their meals together. The outdoor space was maintained and had plenty of seating. All doors were accessed using either a key or fob which maintained safety.

Patients felt the service had plenty of well-trained staff available, who they could approach at any time if they needed to. One patient told us “There’s always enough staff available if I need them, if I ask for time with staff, it usually happens pretty quickly”. Staffing numbers had consistently met the agreed level for the previous 3 months prior to the onsite assessment. There was 1 Nurse in charge and 5 health care assistants through the day, and 1 Nurse in charge and 4 health care assistants through the night, this met the requirement of the service. This allowed staff to meet the patient care and observational needs and ensure that therapeutic activities were provided, and patients leave was facilitated. Managers monitored the acuity of the patient needs within the service and aligned the numbers of staff to it. This ensured that patients had their needs met even when their needs changed. Managers increased staffing numbers at short notice, if patients’ needs changed by using regular internal bank or agency staff. These staff were familiar with the service and patients. Managers monitored staff's compliance with mandatory training to ensure they had the required skills to meet the patients’ needs. At the time of the assessment 98 % had completed the required training. One staff member said, “Training is good, there is all mandatory training and lots of additional courses. Elysium provides funding. DBS and employments checks were all done for me”. There were occupational therapy assistants (OTA) who also facilitated patients leave and activities. Staff were encouraged to learn and progress in their roles. There were multiple learning and progression opportunities for them within the organisation.

Infection prevention and control processes were effective, and ensured that the environment, and equipment was clean, maintained, and audited regularly to ensure they were safe for use. Staff knew what actions to take if there were any concerns with infection control, including if there was an outbreak of infection. Cleaning stations, and hand gel dispensers were situated around the service. Personal protective equipment (PPE) was stored appropriately, and readily available for use. The sluice rooms were clean and in a good working order. Staff involved people in identifying and managing risks relating to infection and hygiene. People were encouraged to report any concerns regarding the environment. All concerns raised were addressed and tended to by the onsite maintenance team.

We could not be assured that people always received their medicines as prescribed. In 2 of the 9 records we reviewed, we identified gaps in the administration of medicines. When people took social leave, staff had not made records of what medicines were given or the quantities provided. We escalated these concerns, and since our assessment the provider has implemented processes and rectified this, providing the required assurances before we concluded our assessment. Staff interactedwith patients kindly and provided support when medicines were administered. Staff adhered to good practice when managing medicines including dispensing, medicines reconciliation, recording and disposal. Staff carried out additional monitoring for medicines where necessary to ensure that they were safe and effective. This included reviewing the effects of each person’s medicines on their physical health according to National Institute for Health and Care Excellence guidance (NICE). Medicines were prescribed in accordance with legal Mental Health Act forms. One patients' medication had been prescribed at a specific time of the day to respect their religious beliefs.