Sherwood Lodge Independent Healthcare

Sherwood Lodge independent hospital provides community rehabilitation for adults with mental health disorders, some of whom may be detained under the Mental Health Act 1983.

During our inspection we raised a number of concerns with the provider and asked that they take action to make immediate improvements. For example, to the environment, equipment and the way risks were assessed for patients and how care was planned.

As a result of the significant concerns identified during the inspection, we wrote to the provider to seek immediate assurances about the safety of those using the service. We advised them that if there was not significant improvement in the safety of care, we would take enforcement action to ensure they address the issues. The provider submitted an action plan describing what it would do to improve and sent us some information to show what actions had been taken. Although we were assured that patients weren’t at immediate risk of harm there is still much for the provider to do to ensure improvements continue and are embedded. We have also identified that the environment needs significant attention to ensure it can meet the needs of patients going forward. The environment is currently not fit for purpose.

As a result of our concerns we have rated the service as inadequate and placed it in special measures. We will continue to monitor the service closely.

Our rating of this service went down. We rated it as inadequate because:

• The environment and equipment were not well maintained. There was broken furniture and other damaged items throughout the premises. The clinic equipment was overdue calibration and a service. Staff had not completed comprehensive assessments of patient needs to ensure the suitability of the environment and allocation of upstairs bedrooms.
• The environment was not fit for purpose and it was difficult to see how staff, despite their best efforts, could provide contemporary community rehabilitative care in this environment. Many bedrooms were very small, some only a single bed length, with limited space to move around next to the bed and furniture. Bedrooms had partition walls in place to create single rooms. The partitions did not reach the ceiling to allow for natural light to enter the side of bedrooms without windows. However, this did not allow for the maintenance of privacy or dignity and patients without access to the windows could not control light or ventilation independently. There was limited room and facilities to support therapeutic activities. Outside space on site was limited to a courtyard that was generally used by those who smoked. There was limited green space and no separate space for those who did not smoke.
• The service did not always comply with same sex accommodation guidance. Staff were unclear on how same sex accommodation was maintained and the bathroom facilities did not allow for suitable gender separation.
• The service did not ensure that risk assessment and risk management processes kept people safe. Patients did not have contemporaneous and robust risk assessment and management plans. Most staff had limited involvement in the development of risk management plans and were not clear on the actions they should take to manage or reduce risk.
• Staff imposed some restrictions on patients without a clear rationale. This included limited access to bedrooms, which some patients did not have keys for and could only access with the support of staff. The service had also imposed financial charges on a patient for damages caused when they were experiencing challenges with their mental health or behaviour without clear rationale and an agreed plan of care in place.
• Staff and managers did not always recognise and report potential patient abuse, and patient safety incidents. Managers did not fully investigate incidents to identify learning and ensure patients were safeguarded against the risk of abuse.
• Managers had not responded to a previous area for improvement highlighted during the last CQC inspection. Care records were difficult to navigate as documents were stored in different locations and files were over full. Staff did not have easy access to care records and were unable to locate the most up to date treatment and management plans. Daily handover records lacked detail and patient needs and risks were not clearly documented.
• The service was registered to provide rehabilitation and recovery to patients, including those detained under the Mental Health Act but the model of care was not clear. The provider stated that they used the Recovery Star model, but this was not clear in care plans. Consequently, patients who should be supported to move on to a less restrictive environment were not receiving the support necessary for their rehabilitation.
• Managers had not ensured that patients had easy access to multidisciplinary professionals including occupational therapists and clinical psychologists in line with a rehabilitation and recovery model of care.
• Most staff were not involved in the review of care and treatment plans and these were not updated regularly. Patients and carers were not always involved in the development or review of care plans and in care decisions.
• Working relationships with the GP surgery had broken down and managers tended to access out of hours service for physical health support rather than accessing support from their local surgery.
• Managers did not implement effective governance processes, that aligned with a rehabilitative model of care, to ensure that performance, quality and risk were managed well.

However:

• Families told us that staff supported, informed and involved them in their family member’s care and patients said they were happy at Sherwood Lodge.
• Staff were generally committed to delivering kind and compassionate care, and it was clear that the majority genuinely cared about patients.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff felt supported by their peers and the leadership team.