Archived: Oakview Hospital

We also received information of concern about the service since the last inspection which informed this inspection visit.

We found significant improvements had been made across these areas and the provider had made most of changes of the changes they were required to make. For example, all agency staff were now trained in the provider's model of restraint before they started working in the service and standards of record keeping had improved.

However, we found there were concerns around the arrangements for accessing emergency equipment and checking that it was working properly. In addition, there continued to be an issue around the blanket restriction of clothing for young people on Green ward. The provider was aware of these issues and was working to improve these issues.

We spoke with young people in the service and received mixed feedback about the service. The young people believed the permanent staff had a positive impact on their progress in the service. However there continued to be issues around the use of agency staff and the impact this was having on young people's experience of care as confirmed by the young people we spoke with. Additionally, access to activities was limited and the young people in the service told us they were not always able to access 1:1 time with staff when they requested this.

We also received information of concern about the service since the last inspection which informed our inspection visit.

We found some improvements had been made across these areas. For example, staffing levels had improved and there had been a marked reduction of incidents in the service.

The provider had action plans in the service to address a wide range of issues. We looked at the senior management team (SMT) action plan last updated on 18 December 2014. Actions were identified with completion dates. For example, in relation to the review of care plans and to ensure that protocols in the service were understood by all staff to sustain the continuity of care for young people. Although there were quality assurance systems in place to manage the risks to people using the service and others, there was a significant amount of work to do to ensure systems were embedded to manage these risks effectively. For example the provider had not taken proper steps to monitor that staff were receiving appropriate supervision. This meant there was a risk that staff were not alerted to people who might require additional support or monitoring. In addition not all agency staff were trained in the provider's model of physical restraint. This meant there was a risk that this could lead to the inappropriate use of physical restraint of young people in the service.

In view of our concerns we took action and served three warning notices for the care and welfare of people, supporting staff and record-keeping informing the provider that they needed to take action to address the areas of non-compliance within a short time frame. We also found the provider was not meeting the standard of monitoring the quality of systems in the service and have issued them with a compliance action.

We spoke with young people and relatives of a young person in the service and received mixed feedback about the service. The young people believed that the permanent staff had had a positive impact on their progress in the service. However the young people did not feel that they had been involved in the planning around their care.

This inspection was carried out in response to information of concern received by the Care Quality Commission (CQC) about recent serious incidents in the service and anonymous concerns raised by staff, young people using the service or their relatives.

Over the last few years there had been a turnover of senior managers in the hospital and more recently a high turnover of frontline staff. This had been an unsettling period for the young people and remaining staff in the service. At the time of the inspection there were 20 vacancies for nursing and support worker posts. Recruitment drives were ongoing. New staff had recently joined the service: a consultant psychiatrist, a clinical psychologist, a hospital director and two ward managers. Seven staff members were due to start employment in the service in August 2014. As a result a high use of agency and bank staff had been used to fill the shift gaps.

The resulting impact of unstable staffing levels in the service involved a high number of incidents in the service, young people not always able to take leave away from the hospital, limited activities and access to therapies.

The provider's governance arrangements for the service had been strengthened. The service had recently introduced weekly meetings for management staff to consider issues of quality, safety and standards. Action plans were in place to address a wide range of issues in the service including environmental risks, the personal alarm system, recruitment and staff training needs. Although this helped ensure quality assurance systems were effective in identifying and managing risks to people using the service and others, there was a significant amount of work to commence as identified by the senior management team's action plan which was last updated in 17 July 2014.

People were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not consistently maintained.

Appropriate arrangements were in place in relation to the recording of medicine administered to the young people.

We found that there were suitable procedures for planning and delivery of care and that staff ensured that the young people were provided with privacy within the boundaries of safety. There were sufficient staff on duty to meet the needs of the people using the service, although the provider was in the process of recruiting more staff and had a process in place for assessing whether staffing levels were adequate prior to agreeing further admissions. There were appropriate safeguarding measures in place and staff had received adequate training. The provider had processes in place to ensure that any incidents or complaints were reported and investigated appropriately.

Staff we spoke with told us the felt unsafe and some staff groups were asked to help when incidents occurred due to staff shortages which was out of their job role.

We found that the numbers of staff on duty were above the numbers stated as required by the providers, however, there were on occasions high numbers of agency or bank staff being employed. This corresponded with higher levels of incidents occurring. The duty rotas were not transparent and easy to see for staff to see who should be on duty on a day to day basis.

Young people told us they felt 'informed and involved in decisions' relating to his care plan/treatment and said 'when I wanted to know more about my medication, information sheets were provided'. Another young person said that his key worker was 'very good'.

We found that the environment was clean and tidy and there were systems in place to ensure that cleaning schedules and checks were completed on a daily basis. The young people were involved in their treatment plans and gave consent to care. Where the young people were not able to give consent there was a system in place for assessing mental capacity. We found that the young people who used the service were involved in their care planning and received personalised care and support which was based on an assessment of their needs. Staff received suitable support and supervision although not all staff had received an annual appraisal.