Archived: Vision MH - Cornerstone House

Updated 4 April 2022

Vision MH Ltd provides a hospital service at Cornerstone House with in-patient accommodation for people to receive rehabilitation care and treatment for a range of mental health issues.

The service treats and supports patients with a range of mental health disorders. The service specialises in treating people with personality disorder using an evidence-based treatment modality. In addition, the service provides a more traditional rehabilitation and recovery role for those people suffering from a psychotic illness (schizophrenia, bi-polar disorder, dual diagnosis).

Cornerstone House is a large detached house with an additional annex within the grounds. The hospital is situated approximately one mile from the local high street, shopping, leisure activities and a rail link.

The hospital has 32 registered beds and provides treatment for both informal patients and persons liable to be detained under the Mental Health Act 1983 (2007). The unit offers a treatment and recovery based mental health service that provides assessment and active, intensive multidisciplinary care and treatment for individuals suffering from mental illness.

The most recent comprehensive inspection of Cornerstone House was in October 2017. The service was rated good for effective and responsive, and outstanding for safe, caring and well-led. The service was rated as outstanding overall.

On 8 and 9 April 2021, the Care Quality Commission (CQC) conducted an unannounced focused inspection. The inspection was undertaken in response to concerns the Care Quality Commission (CQC) had received, in relation to a high number of patient self-harm incidents. The report was published on 28 June 2021.

During the inspection, we looked at specific key lines of enquiry of safe, caring and well led. The provider was rated as inadequate for safe, caring and well led and was given an overall rating of inadequate. The provider was placed in special measures.

Following our inspection in April 2021, the provider was issued with an urgent letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. The provider was told to submit an action plan within 24 hours that described how they would address our concerns. Their response provided enough assurance they had acted to address immediate concerns, and the provider developed a robust action plan to address areas of concern. We continued to monitor progress against their action plan through regular engagement and submission of evidence for review.

As a result of this inspection we have removed the provider from special measures.

What people who use the service say

We spoke with five patients. All patients reported that the provider used high number of agency staff. All patients said the ward was clean, however one patient stated their bedroom was not always cleaned regularly. Patients said most staff treated them well and behaved kindly. However, three patients said that agency staff could be rude. All five patients stated they had been involved in their care, however none of the patients interviewed had been involved in making decisions about the service.

We spoke with nine family members during the inspection who gave mixed views of the services. Two out of the six family members we spoke with (33%), reported that their family member did not always feels safe. Five carers stated staff were caring and interested in patient’s wellbeing.

All the patients and staff we spoke with mentioned the high use of agency staff and 67% stated the service had improved.

Updated 4 April 2022

Cornerstone House is an independent mental health in-patient unit based at Borehamwood, Elstree. The hospital has 30 registered beds and provides treatment for both informal patients and persons liable to be detained under the Mental Health Act 1983 (2007). The service specialises in treating people with personality disorder and provides a rehabilitation and recovery role for those people suffering from a mental illness.

Our rating of this location improved. We rated it as requires improvement because:

• Not all staff were in receipt of regular supervision
• Not all staff were up to date with the prevention management of violence and aggression (PMVA), and de-escalation training.
• The provider had not maintained cleaning records for the clinic and treatment room.
• Staff had not always conducted physical health checks in line with identified patient need, and scores were not always recorded correctly.
• Patient risk assessments had not been updated following each patient incident.
• Staff had not used clinical outcome tools to measure patients’ rehabilitation progress.
• The provider did not use a side effect monitoring tool for patients on high dose anti-psychotic medication.
• Capacity assessments had not been undertaken for all patients.
• Care plans demonstrated involvement of patients, but 40% of patients we spoke with, said they had not received a copy of their care plan or had been involved in a review.
• Patients did not have access to snacks throughout the day.
• Patient complaints had not always been responded to within the required timescale

However:

• We noted improvements in safe, caring and well led domains since our last inspection.
• The service generally had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm. Agency staff were block booked to ensure patients had consistent care.
• Staff stored, managed and audited medications effectively.
• Mandatory training and appraisal compliance were good.
• Staff understood how to protect patients from abuse. Staff had received training on how to recognise and report abuse and they knew how to apply it. Two freedom to speak guardians had been appointed and staff knew how to raise issues.
• Managers had the skills, knowledge and experience to perform their roles.
• Robust governance systems and processes were in place to improve and monitor the performance of the service.
• Senior managers had made significant steps to address concerns identified at our previous inspection. Staff morale, team working, and communication had improved. Poor performance of staff was managed effectively.

Updated 4 April 2022