Archived: Vision MH - Cornerstone House

We rated Vision MH – Cornerstone House as good because:

• Care records and plans were all up to date, personalised, holistic, recovery orientated. Staff offered patients copies of their care plans and signed to say that had received or declined a copy. Care records showed that a physical examination had been undertaken and that there was on-going monitoring of physical health problems, which included monitoring of patients on medication.
• Staff completed a risk assessment of every patient on admission which was reviewed and updated after incidents.
• The service had its required established levels of staffing to meet the needs of the patients and offer 1:1 time with staff. Staff rarely cancelled escorted leave for patients due to staff shortages.
• Patients reported that they felt safe at all times. Staff were always in the day area and very supportive. When on 1:1 observations, staff treated patients with complete respect and care.
• Staff interacted with patients in a caring manner, remained engaged and interested in providing good quality patient care. We saw that staff were responsive to patient needs, discreet and respectful.
• Staff could not observe all parts of the wards due to its layout. Managers mitigated this risk by placing mirrors in corridors. Managers had identified ligature risks by carrying out a ligature audit; managers reduced these risks through a comprehensive refurbishment plan. A ligature point is a fixed item to which a person could tie something for the purpose of self-strangulation.
• There had been a total of 24 incidents of restraint between 26 August 2015 and February 2016 involving eight patients. Staff told us that the use of restraint was a last resort and that de-escalation techniques were used to distract and engage patients as a first response, this was evidenced in case records.
• Medicines were stored securely and in accordance with the provider policy and manufacturers’ guidelines. We reviewed all medication administration records (MAR) and found no errors or omissions of nurse signatures when the medication had been administered.
• Staff followed the National Institute for Health and Care Excellence (NICE) guidance when prescribing medication and provided psychological therapies recommended by NICE.
• Staff had access to supervision every two months in line with the service policy. Staff attended weekly reflective practice meetings weekly which they found supportive, and enhanced their knowledge and clinical practice.
• Patients had access to the independent mental health advocacy (IMHA) services.
• The service had a range of rooms and equipment to support treatment and care. This included treatment rooms to examine patients, a gym, therapy kitchen, art room, group therapy room, and quiet room. Patients also had access to a large garden. Patients had individual therapy timetables that provide then with occupational and recreational activities.
• Managers completed comprehensive audits to ensure the service improved the care that staff provided to patients.
• Staff had the ability to submit items to the services risk register. The register highlighted control measures that were in place to mitigate the risk and planned measures to meet in order to reduce the risk within a set time frame.
• Staff reported that they were proud of their team and that they enjoyed their job. The team, including senior staff, were supportive and welcomed feedback and new ideas. Staff were able to describe their duty of candour as the need to be open and honest with patients when things go wrong.
• Managers ensured that staff met the minimum target of 80% forall mandatory training

However:

• We found two errors in the controlled drug book. The error was an inputting error not a medication error, the service’s pharmacist and staff rectified the error quickly to ensure that that the medication was reconciled.
• During the inspection, the registered manager reported that a medication error had taken place. The registered manager sought medical help for the patient immediately and provided a plan of the action taken to prevent this incident from reoccurring.
• Managers did not hold specific team meetings with nursing staff. Information was shared with them in the morning handover.

We carried out an unannounced focused inspection of this service following concerns identified to the Care Quality Commission.

We do not rate services that we inspect as part of a responsive inspection. We found that action was required by the provider because:

• Staff could not observe patients effectively in all parts of the ward. The service had installed mirrors to aid observation, but staff had not placed where needed. As a result, lines of sight were not clear.
• Staff did not seek appropriate levels of medical attention when patients harmed themselves.
• Managers undertook ligature risk assessments and staff had identified ligature points throughout the service, where patients might be able to harm themselves.. However,staff had taken no action to minimise the risks to patients.
• The ward did not comply with mixed-sex accommodation guidelines, as there were no separate day spaces for women.
• Staff were nursing one patient in long-term segregation to prevent the risk of harm to other patients and to themselves. Staff had not completed management plans or multidisciplinary reviews of this to ensure the patient was safeguarded in line with the Mental Health Act code of practice.
• Cleaning records showed that cleaning took place regularly; however, some areas of the service were not clean. Three bedrooms inspected were dirty and had an unpleasant odour. Ensuite facilities in two bedrooms had stained toilets and flooring.
• The emergency drugs held in the clinic room were out of date. Staff did not check medication regularly or effectively as this error was unnoticed.
• The service did not manage stock medication or controlled drugs in line with Nursing and Midwifery Council standards. We found errors in both the dispensing of, and recording of, controlled drugs. Staff did appropriately manage the recording of stock medication.
• Medication was stored in a fridge, which staff records showed, had temperatures that were higher than the accepted range. The fridge also contained solid ice. This could have changed the effectiveness of the medication. Staff had taken no action to address this.
• The service used blanket restrictions, such as limiting patients’ access to mobile phones and to the internet. This was not individually risk assessed.
• Staff knew how to report incidents and used an electronic system to do this. However, those report records reviewed were incomplete and lacked information about the incident and the lessons learned.

However,

• There were alarm call bells in patients’ rooms, which meant they were able to call for help if they needed it.
• Staff completed risk assessments and updated them when the risk to patients changed.
• The hospital had enough staff on shifts to meet the needs of patients on the ward. Managers could adjust the staffing levels if required.
• Eighty-one percent of staff had completed mandatory training.
• Staff interacted with patients in a positive way and showed good understanding of individual needs.