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Inspection Summary


Overall summary & rating

Good

Updated 13 August 2019

We rated St Matthews hospital as overall good because:

  • The provider had established the staffing levels required to meet the needs of the patients. The hospital manager had the autonomy to increase staffing levels if required. Staff training was all above 75% compliant. Staff received regular supervision and annual appraisal in line with the company policy. All wards complied with the Department of Health guidance on eliminating mixed sex accommodation. There was suitable medical cover and on call cover throughout the week.

  • We reviewed 11 care and treatment records and found evidence that patients received a comprehensive risk and physical health assessment on admission. Patients were involved in developing their care plans and were outcome focused. The hospital offered a range of psychological interventions recommended in the National Institute for Health and Care Excellence guidelines.

  • Patients knew the complaints process and had access to an independent mental health advocate if requested. Staff were aware of the provider’s whistle blowing policy and knew their responsibilities in relation to safeguarding. Staff told us they felt confident to raise concerns to senior managers without being victimised.

  • The manager had oversight of the hospital. Performance was monitored by completing regular audits and the outcomes were recorded on key performance indicator dashboards. This meant the manager could monitor performance over a period of time to ensure continuous improvement.

However:

  • We found the provider had completed a ligature assessment and had taken steps to mitigate the risks. However, the provider did not have a formal action plan in place to remove ligature anchor points in line with NHS England’s standard contract for low secure services. This states that, Low secure services “will meet” the best practice guidance from the Royal College, and that in low secure service wards: furnishings minimise the potential for fixtures and fittings being used as weapons, barriers or ligature points.

  • There were blind spots throughout the ward areas which meant staff were not able to have clear lines of site. There was evidence of some convex mirrors used however not all blind spots were mitigated appropriately.
  • We found some maintenance issues that were not identified or reported. For example, Radiator covers throughout were damaged.
Inspection areas

Safe

Requires improvement

Updated 13 August 2019

We rated safe as requires improvement because:

  • There were blind spots throughout the ward areas which meant staff were not able to have clear lines of site. There was evidence of some convex mirrors used however not all blind spots were mitigated appropriately.

  • The provider did not have a formal action plan in place to remove ligature anchor points in line with NHS England’s standard contract for low secure services states that, low secure services “will meet” the best practice guidance from the Royal College. This states that in low service wards: Furnishings minimise the potential for fixtures and fittings being used as weapons, barriers or ligature points.

  • We found some maintenance issues that were not identified or reported. For example, radiator covers throughout were damaged.

However:

  • The wards had enough staff with relevant skills, experience and training to provide recovery focused care and treatment that kept people safe from avoidable harm.

  • Staff completed holistic risk assessments that informed risk management plans for all patients. Risk management plans were based on positive risk taking.

  • Staff followed best practice in anticipating de-escalating and managing challenging behaviour. Staff used restraint after attempts of de-escalation had failed.

  • Staff understood how to protect patients from abuse and/or exploitation and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and/or exploitation and they knew how to apply it.

  • Staff followed best practice when disposing of medicines. Staff regularly reviewed the effects of medicines on each patient’s physical health. Patients were supported to recognise side effects of medicines for themselves and seek help when required. However, all emergency equipment and emergency medication were stored in different parts of the clinic room. This meant there could be a delay in staff gathering all items required in an emergency.

  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Effective

Good

Updated 13 August 2019

  • Staff developed care plans, personal to the patients which were based on their strengths. The care plans covered a range of areas of need and were focused on recovery goals. Staff reviewed the care plans with the patients at regular intervals and recorded the changes.

  • Teams reviewed patients care plans through multidisciplinary meetings on a weekly basis; these reviews involved patients and carers.

  • Staff assessed the physical health of patients on admission and annually. Staff carried out routine physical health checks based on individual needs.

  • Staff developed care plans which related directly to identified risk assessments and management plans.

  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. The team provided a range of therapies that promoted recovery and followed national guidance on best practice. This included access to psychological therapies, activities to promote social and personal identity, daily living skills and support to live healthier lives. Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.
  • Staff supported patients to make decisions on their care for themselves. Staff used considered the Mental Health Act and the Mental Capacity Act where necessary. Staff assessed patients’ capacity to make decisions on all aspects of their care when required.

Caring

Good

Updated 13 August 2019

We rated caring as good because:

  • We observed times when staff interacted with patients in a kind and compassionate manner. Staff took time to get to know and understood their patients’ needs. Staff treated patients with respect, compassion and kindness and protected privacy and dignity. They understood and respected patients’ cultural, social and religious needs.

  • Staff used the patients’ preferred communication approaches to ensure that patients understood their care, treatment or condition.

  • Staff worked in partnership with patients to formulate and review care plans, goal setting and risk assessments. They actively sought patient feedback on the quality of care provided.
  • The service sought family and carer feedback regarding the quality of the service and care provided.

However:

  • Patients newly admitted to the service did not have access to a welcome pack.

Responsive

Good

Updated 13 August 2019

We rated responsive as good because:

  • The hospital did not have any delayed discharges over the last 12 months.

  • St Matthews had a full range of rooms and equipment to meet the needs of the patients. Each patient had their own bedroom with an ensuite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.

  • The wards met the needs of all people who use the service – including those with protected characteristics. Staff helped patients with communication, advocacy and cultural and spiritual support.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

  • Patients told us they knew the process to raising a complaint.

Well-led

Good

Updated 13 August 2019

We rated well-led as good because:

  • Leaders were committed to providing a recovery-based service and could explain their model of care. Leaders had a good understanding of the service they managed, and it adhered to a recognised model and guidance of rehabilitation care.
  • Leaders were visible, approachable to staff and patients.
  • Leaders were able to develop and demonstrate the right skills to lead and influence a high-quality rehabilitation service.
  • Leaders used a sound evidence base and innovation to shape the service. The service strategy reflected a recovery-oriented model. The service strategy was aligned to the local rehabilitation pathway.
  • Staff felt respected, supported and valued and felt proud to work for the service.
  • We saw robust arrangements and processes to ensure effective oversight of ward level performance and management of risk. Leaders had oversight of key issues in delivering high quality rehabilitation care. Staff at all levels were clear about their roles and what they were accountable for and to whom.
  • Feedback from staff, patient’s, carers and external partners was used to shape and improve the rehabilitation service.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 13 August 2019