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

Archived: Olive Eden Hospital

Overall: Good read more about inspection ratings

71 St Paul's Road, Tottenham, London, N17 0ND (020) 8885 8750

Provided and run by:
Liaise (London) Limited

All Inspections

7 November 2018

During an inspection looking at part of the service

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

  • The service now provided safe care. The environment was safe and clean. There were enough staff on duty. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.

  • Staff developed care plans informed by a comprehensive assessment. The physical health care needs of patients were identified and met.

  • The nursing staff worked well with doctors and therapists to provide care and treatment and to develop goals for patients to become more independent.

  • The service was well-led. Leaders had ensured that the quality of the service had improved since our previous inspection in August 2017. Health and social care regulations were met.

  • Leaders of the service had begun the process of transforming the service from a hospital to two separate care homes.

    However:

  • Record keeping systems at the service made it difficult for staff to ensure all patient needs were met.

  • Staff reviewing positive behaviour support plans did not record how they had used information on incidents to update these plans.

10,11,14 and 20 August 2017

During a routine inspection

This was a focused inspection we reviewed and rated the safe and well-led domains. At the previous inspection in May 2016, we also identified a small number of concerns for the effective and responsive domains. At this inspection we assessed the progress made by the service. We also identified and reported on some new concerns in each of the domains. Therefore, we have re-rated the service as inadequate overall.

We found the following areas that the service provider needs to improve:

  • Staff did not always ensure that patient risk assessments and care plans contained accurate and up to date information. This meant we could not be assured that patients’ physical health needs were fully met.
  • Robust safeguarding processes were not in place and staff had not been suitably trained in safeguarding children. Staff had not sought advice from the local authority safeguarding team after some incidents, to establish whether a safeguarding alert was necessary. Staff did not always ensure patients privacy and dignity was protected. Some patients were deprived of their liberties without lawful authorisation.
  • Individual patients did not consistently receive support from the required number of staff. Staff who worked at the service had not all completed appropriate training to care for patients. For example, there were low levels of compliance with training on diabetes and epilepsy. There were patients at the hospital with diagnoses of these conditions.
  • Whilst overall medicines management practice was good, there were two occasions in the last six months when patients had not received or were at risk of not receiving their prescribed medicines.
  • There were fire safety concerns at the service. The service had not implemented some of the agreed actions following a fire risk assessment in June 2017. Some firefighting equipment was not easily accessible.
  • Staff had not reported all incidents which had occurred and there were inconsistencies in the recording and reporting arrangements and the provider’s policy. Incidents were not always investigated in line with the service policy and the provider had not implemented a suitable process to support staff to learn lessons from them.
  • The standards of cleanliness in the kitchen on the male unit were not consistently maintained and some food was out of date.
  • The service did not have robust governance arrangements to maintain the safety and quality of the service provided to patients. Quality assurance arrangements were not robust and policies and procedures were not all up to date. Team meetings lacked structure and staff had limited awareness of about local risks. Staff had not received an annual appraisal.

However:

  • Staff were trained in de-escalation techniques, they used verbal de-escalation and did not restrain patients. Staff did not use seclusion or rapid tranquilisation.
  • Staff spoke positively about their experience of working at the service and found the hospital manager to be supportive and approachable. Appropriate levels of medical cover were available 24 hours each day.
  • The provider had systems to ensure staff were up to date with mandatory training and that pre-employment checks were carried before staff commenced their employment.
  • Clinic rooms were clean and appropriately equipped and patients and staff had access to call alarm systems.
  • The provider had systems in place that showed adherence with the Mental Health Act so that patient’s rights were protected.
  • Senior managers had responded to the staff survey 2016, and introduced an awards programme for staff.
  • Staff knew how to use the whistle-blowing process and to report any concerns. Staff reported a good culture of team working, mutual support and the satisfaction of working in a supportive environment.

After the inspection we wrote a letter to the provider saying we would potentially take urgent enforcement action using section 31 of the Health and Social Care Act if they did not take immediate action to improve the safety for the patients in the hospital. The provider voluntarily agreed not to accept any new admissions into the hospital and has provided an ongoing action plan explaining the improvements that are being made.

We also served a warning notice for regulations 12,17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014 as we were significantly concerned about the impact of these beaches on the care and welfare of the patients at this hospital.

4, 5, 16 May 2016

During a routine inspection

We rated Olive Eden Hospital as requires improvement because:

  • Whilst patients had a number of risk assessments in place, these were not always reviewed or updated following an incident. Staff were recording incidents of restraint but these did not include the length of time restraint was used.

  • There was a lack of proper management of patients’ care records, incidents and informal complaints. Patient care records and information was not kept in a consistent or accessible way. Patient needs and how these were being met were not clear in multiple care plans, files and records. The was a lack of clarity in data collected and overall analysis around incidents.

  • Discharge plans were not all detailed, personalised or person centred. The extent to which patients achieved their goals linked to their discharge plans were not clear.

  • Patients had mixed views about their activities. Whilst a programme of activities was in place for each patient, there was variable feedback from patients about their level of satisfaction with activities.

  • Family members expressed dissatisfaction about the handling and response to their informal complaints regarding their relative’s care and treatment. Informal complaints records were not easily accessible. There was no effective system in place to ensure informal complaints were addressed in a timely manner.

However:

  • The provider had made improvements to ensure that they managed medicines safely.

  • We observed a good standard of cleanliness throughout the service.

  • There were sufficient staff and an appropriate skill mix. There were enough staff to ensure patient safety.

  • Staff were made aware of incidents and debrief discussions provided staff with opportunities discuss and learn from incidents in team and one to one meetings.

  • Staff regularly monitored patients’ physical health and patients accessed the GP, dentist, optician and chiropodist on a regular basis.

  • Patients had access to psychological assessments, their individual behaviour was monitored and they had positive behaviour support plans in place. There was a strong multidisciplinary team (MDT) who were available to patients when they needed.

  • All staff had completed the corporate induction prior to commencing full duties. Staff had regular supervision and the majority had annual appraisals. Staff completed mandatory and specialist training in relation to the needs of patients using the service.

  • All the documentation relating to the Mental Health Act for the detained patients was available to view and in good order. Patients had a record of their consent to care and treatment in place and their rights explained to them on admission and routinely after.

  • Patients were supported to make decisions and where they lacked capacity, there were procedures in place to enable best interest decisions to be made. The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training was mandatory and staff showed good awareness of the principles.

  • Patients said staff were kind, caring, understanding and supportive. We observed that staff had developed a good rapport with patients and understood their individual needs. Staff treated patients with dignity and respect and provided practical and emotional support. There were positive interactions between staff and patients.

  • There were a sufficient range of rooms and outside and quiet areas where people could go and engage in activities.  Patients were permitted to smoke in outside areas.

  • There had been changes among senior management in the past five months, including a new area manager and operations director who were reviewing systems and procedures aimed at improving the service. All staff said they had good support from the manager who knew the needs of patients well and was improving the outcomes for patients using the service.

  • Quality monitoring through processes such as audits were identifying areas of improvement and these were mostly being followed through. Collation of incidents, use of physical intervention and formal complaints was provided. This enabled trends across the service and areas of improvement to be identified. However, there was not a robust system to manage informal complaints.

4 February 2015

During a routine inspection

The service could accommodate up to 14 people. At the time of our inspection there were nine people using the service. During our inspection we visited the male and female units. We spoke with seven people who use the service and/or their relatives. We spoke with seven staff of different disciplines which included nurses, rehabilitation facilitators, assistant psychologist, speech and language therapist and occupational therapist. We also spoke with the manager and operations manager for the service.

We attempted to contact the care manager/co-ordinator of each person who uses the service and the advocates who visit Olive Eden Hospital. We received feedback from seven care managers and two advocates. Prior to the inspection we also received some feedback from the local safeguarding team. The service had recently agreed to be used as part of a pilot for the 'Winterbourne Reviews'. This was part of the NHS England commitment to transforming care for people with learning disabilities and/or autism who have a mental illness or whose behaviour challenges services. We received feedback from some of the Clinical Commissioning Group staff who were involved in carrying out the reviews.

The general feedback from professionals was that some very good work was taking place and staff have good understanding of needs, but that this was undermined by a lack of communication within the service and with external professionals involved in peoples' care.

The people we spoke with said they were happy with the service and the staff were kind and caring. We observed that the staff displayed a caring attitude with people.

The care plans were individualised and kept under regular review. However, there was a lack of evidence of the involvement of people in their care plans.

Staff knew about different types of abuse and the local procedures for reporting these.

However, people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely.

17 June 2014

During a routine inspection

During our inspection we spoke with five people who use the service, one relative of a person who uses the service and a minimum of ten staff, which included the unit manager, support workers, nurse, support managers, governance lead, art therapist and occupational therapy assistant.

People who use the service generally spoke positively about the support they received and how they were able to pursue individual interests. They said the staff were caring and available when needed.

The staff conveyed a clear knowledge of each person's needs and how they liked to be supported. We observed that the people who use the service and the staff had developed positive relationships with each other.

People were involved in identifying where they needed support and how this was to be provided. This was reflected to some extent in the care plans and risk management plans which detailed how people's needs were to be met during their stay at the hospital.

People were supported with their nutritional needs and had access to a selection of foods to meet their dietary and cultural needs.

The service worked with other providers to support people with their needs and developing new skills.

The systems for the management, recording and storing of medicines was robust and ensured people were supported with these safely.

Staff received support and training to ensure they were competent to support people with their needs.

5 November 2013

During an inspection looking at part of the service

When we visited the hospital we interviewed eight members of staff and spoke to others in passing. We spoke with or observed eight patients. One patient said they were 'very happy' there and had made a friend.

We saw that the provider's new senior managers had made many positive changes to the service since our last visit in April 2013. Staff training was being improved and a new induction programme was in place. A new manager had just started in post and a new post of business support manager had been created to support service improvement. This meant the provider was starting to get a good overview of the strengths and challenges of the service. We saw evidence that plenty of work to improve the foundations of the service had already been carried out or was underway, for example, the multi-disciplinary team had been strengthened. Staffing levels were sufficient to meet the patients' needs.

However, on the day of our visit, we found that some poor practice was still in place on the men's unit. In particular, we found that the staff on duty were passive and, whilst they kept people safe, they were not engaging with patients in a way that the patients were likely to understand. We were also concerned that none of the male patients had freedom to access their bedrooms or toilet facilities without staff support. When we brought these matters to the attention of the managers, they promised to quickly put them right, but they were not right on the day of our inspection.

12 April 2013

During an inspection looking at part of the service

There were eleven people at Olive Eden at the time of our inspection. Three people were detained there under the Mental Health Act. We were able to speak with five people. The other people were either out or unable or unwilling to talk to us. We also spent some time observing people who were unable to talk to us. Three people told us they were ready to move on from Olive Eden and live in supported living or in a care home. They told us plans for moving on had been discussed with them by staff at the hospital.

At the time of this inspection the manager was on leave and then left the service and the deputy was acting manager.

People said they generally got on well with staff. One person said, "Staff are friendly and helpful." Another person said that they got on well with most staff and that they knew how to support them. This person said, "they know how to calm me down." One relative made some comments about the service on our website and told us that they were very happy with the way that Olive Eden had worked with their relative who had made very good progress since they had been there. We spoke with this person who also shared this view and said they felt they were doing really well since being at Olive Eden.

We found that one to one staffing may not have been provided when people had been assessed as needing extra staff support. We found that there was not enough evidence of a robust quality assurance system and lessons being learned from incidents.

15 November 2012

During an inspection looking at part of the service

We spoke to eight people who were living at Olive Eden. The other people were either out or not able/willing to talk with us.

People told us they liked going out. They said staff went with them to do activities they enjoyed, such as shopping, trampolining and cinema. We asked people what it was like to live at Olive Eden. Four people said it was "good" or "nice" or "alright" living at Olive Eden.

One person said "it's in between" and explained they were not happy as they had been assaulted by another person. One person said "I didn't like it when staff locked me in my room" but did like "going out and about to lots of places."

2 May 2012

During a routine inspection

We talked to nine of the thirteen people currently living in Olive Eden hospital on the first day of our inspection. The second day of the inspection was to complete an interview with the manager and inspect some records.

People gave mixed views about Olive Eden. In answer to the question 'What do you think of it here?' replies included, 'It's alright,' 'I like it here' and 'It's disgraceful." This person wanted to move out.

Two people said they would like to go out more often. One said 'There's not enough activities. They are busy.'

People told us they had good support with their physical health needs and diet. Two people told us they were being supported to eat a healthy diet and one person had lost weight with staff support. One person said they were able to make themselves a cup of tea with staff supervising them. People said they liked making their own food when they had an opportunity.

One patient told us that they thought the hospital was short staffed and that this meant there could be a delay when they wanted to go out or to have a cup of tea.

Three of the seven people we asked said they did not feel safe at Olive Eden. Four said they did feel safe. One said they did not feel safe because they had been hurt by another patient who pulled their hair and another patient fights with them.We checked and found this was true.

We asked one patient what could be improved about Olive Eden and they said 'the fights could be improved.'

18 November 2011

During a themed inspection looking at Learning Disability Services

We heard from patients that staff were nice and treated them well, doing things like explaining their medicines to them. We heard of the outings that patients had enjoyed with staff support, such as pub visits, lunches out, daytrips and shopping. Patients told us they enjoyed the activities.

A patient said they wanted more activities to do in the hospital, especially in the mornings, so they had a reason to get up and something to look forward to.

One patient told us that they had waited a long time for staff to bring them their morning cup of tea and breakfast on one of the days we visited.

We spoke with relatives of two of the patients. They told us they were satisfied with the hospital and they found the manager approachable. We heard examples of how they had been involved in their relatives care and kept informed of their progress. One told us their relative had been happy and had made progress at the hospital.

Staff told us that Curo Care Limited had provided them with regular training about how to care for people and keep them safe. We heard that company directors and clinicians had provided training, advice and support. In addition we were told that senior staff visited the hospital regularly and were available in an emergency.

When we visited the hospital one patient made an allegation that they had been abused. We spoke to Curo Care Limited about this straight away and they took immediate action to safeguard the patient. They then contacted Haringey social services 'safeguarding of vulnerable adults' team so that the allegation could be investigated.

As a result of this investigation Haringey Social services have advised us that they have asked Curo Care Limited to review their safeguarding procedures so that they comply with London wide safeguarding procedures.

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.