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

Archived: Bigfoot Independent Hospital

Overall: Inadequate read more about inspection ratings

4 Birch Hall Lane, Longsight, Manchester, Lancashire, M13 0XE (0161) 248 6796

Provided and run by:
Equilibrium Healthcare Limited

All Inspections

8 August 2016

During an inspection looking at part of the service

This was a focussed inspection relating to issues identified at a previous inspection and where warning notices were served. Ratings have not been given for this inspection.

Warning notices were issued following a comprehensive inspection in March 2016. At this inspection we assessed whether issues identified in three warning notices had been addressed. We found improvements in terms of staffing, dignity and respect and safe care and treatment and that these warning notices had been met.

The service will continue to be monitored whilst in special measures and a further comprehensive inspection will take place to assess all areas identified at the previous comprehensive inspection.

21 – 23 March 2016

During a routine inspection

The CQC is placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made, and there remains a rating of inadequate overall or for any key question, we will take action in line with our enforcement procedures. At this point, we would begin the process of preventing the provider from operating the service. This will lead to cancelling the providers' registration at this service, or varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We rated Bigfoot Independent Hospital as inadequate because:

  • There was poor governance in relation to the oversight of issues arising at the hospital and communication between the hospital management and the operational and board level.
  • There was poor oversight and awareness of the Mental Health Act 1983 and the Deprivation of Liberty safeguards.
  • The hospital was not managing medicines safely. We found several examples of dangerous medicines management including intramuscular medication given without a valid prescription, the wrong doses of medication given, patients being treated with high dose antipsychotic medication without additional monitoring, out of date medication and dressings and unsafe storage in the form of malfunctioning medicines fridges.
  • We were concerned about staffing levels across the service, particularly within one ward with complex patients who required high levels of support. Staffing levels of qualified nursing staff were not safe. Qualified nurses on duty covered more than one ward, particularly during night shifts but also during the day.
  • Staff did not receive the training required for their role. We found that staff had received basic one day training in learning disability, with no training in autism, communication needs and assessment, epilepsy or person centred planning.
  • There was a lack of rehabilitative focus, with little evidence of discharge planning, little structured rehabilitative activity or assessment, poor access to psychological input and very little evidence of outcomes planning, monitoring or progress for patients. There were no links into community rehabilitative or structured resources or support to access these.

We raised our concerns about the quality of care being provided at the time of the inspection.

The provider took immediate steps to address shortfalls which included:

  • extra senior management support
  • an increase in staff,
  • commissioned an independent review of all detention papers,
  • an investigation into the detention errors and addressing the issue of informing patients and relatives
  • changing provision of pharmacy support.

We also shared our concerns with the commissioners of the service. We have taken enforcement action and we will be working with the provider to ensure that improvements are made.

3 December 2013

During a routine inspection

We spoke with some of the people who used the service and found that overall people were happy with the service they received. We observed interaction between staff and people who used the service and found that people appeared to be relaxed around staff. Staff spoke to people in a friendly and respectful way. One person told us: "I like the staff, they're alright."

We found people had care plans in place which provided information about the support they required. Care plans were reviewed regularly to ensure they were up to date and appropriate.

People had access to other healthcare services such as the GP or dentist when required and people were supported to understand their rights under the Mental Health Act 1983.

All nursing staff had received life support training and there was resuscitation equipment available so staff could respond appropriately in the event of an emergency.

19 August 2013

During an inspection in response to concerns

We did not speak to people who used the service as part of this inspection. We carried out this inspection following concerning information we received relating to staffing levels and how the provider supported staff to undertake their role. We also received information of concern relating to checks the provider performed to ensure people were fit and safe to work with vulnerable people.

We found the provider had robust recruitment and human resource policies and procedures in place. The provider carried out appropriate pre-employment checks. They also had systems in place to review staff's ability to fulfil their role safely.

Staff received relevant training, supervision and appraisal. Staff told us they felt supported to fulfil their role. They told us they felt comfortable raising concerns with their manager and that their manager would take appropriate action as a result.

We saw there were enough suitably trained and qualified staff on shift and that the provider had systems in place to cover staff sickness and absence.

A complaints procedure was in place along with a complaints record which showed the provider had systems in place to deal with comments and complaints from staff and people who used the service.

27 February 2013

During a routine inspection

We spoke with some of the people who used the service and two relatives, they told us they were happy with the service they received. Comments from the people who used the service included: 'It's lovely here'I feel safe here', 'They're [staff] nice, they're good the staff are' and 'It's alright'you can talk to the manager'. Relatives told us: 'I can't praise the people there enough...[my relative] is a changed person for the better' and 'It's such a lovely environment'.

Care plans and risk assessments were in place for people who used the service which meant they experienced effective and appropriate care, treatment and support which met their needs.

People were involved in regular reviews of their care plans and were supported by an independent mental health act advocate which showed people were enabled to participate in making decisions about their care.

We found the service was clean and tidy with clear infection control procedures in place. People had access to a choice of suitable food and drink which meant they were supported to have adequate nutrition and hydration.

A complaints procedure was in place which was clearly displayed in easy to read format. A record was in place which showed the provider had systems in place to deal with comments and complaints. Staff received relevant training, supervision and appraisal which meant they were supported to deliver care safely and to an appropriate standard.

8 November and 20 December 2011

During a themed inspection looking at Learning Disability Services

We visited Bigfoot independent hospital which provides care for up to 28 men aged 18 and over with learning disabilities and additional specialist needs. There are five units and there were 20 patients staying at Bigfoot when we visited. The inspection team met and spoke to over half of the patients over the two days to get their views of the service.

Patients said that staff were supportive. One patient said, 'The staff are great. They look after us and take us out all over.' Relatives of patients were pleased with the care provided and able to ask any questions of staff. Most relatives felt involved with the care and that staff listened to them. A relative said her family member was 'very happy' at Bigfoot Hospital.

Patients' activities were varied and frequent and we observed most patients going out individually during our visit. One patient told us he went gardening, swimming, had visits to the library and the market. Another patient told us about a recent trip he went on to Blackpool and going to a bonfire, which he enjoyed immensely.

One patient was booking a short break away with staff during our visit. This patient enjoys frequent overnight breaks rather than one long holiday and enjoys planning the holiday as much as the trip itself. He said, 'I enjoy going on holiday. I have just booked one. I really am excited.'

Patients told us they felt safe and well cared for. One patient said, 'If I have been upset or worried, staff have helped me'.

9 November 2011

During a routine inspection

Everyone we spoke to during this visit gave us positive feedback overall about their care. People said that the staff listened to them and they had copies of their care plans in a format they could understand. People said the staff supported them well and described activities they liked to do both at the hospital and in the local community. People were generally happy with the amount of community leave they had and some people told us about holidays they were planning with support from staff. Three people said their leave was sometimes restricted due to a lack of staff or the use of agency staff and this was fed back to the provider.

1, 3 March 2011

During an inspection in response to concerns

The feedback we received from the people using this service was positive overall. One patient told us that coming to the hospital was 'the best move I ever made' and said he was happy. Another patient said "it's all right here, I'm well looked after, the staff do a good job". Most of the people we spoke to said that they liked their doctor and they felt they got to see the doctor often enough. Several patients complained that their leave is sometimes cancelled because there is no staff member available to go out with them. One patient said he thought his ward was short staffed. All but one of the people we spoke to said they felt safe. The person who said he didn't always feel safe said this was due to the ward being noisy but he said that when he was worried he spoke to a member of staff and they would help him. Most of the people we spoke to said they knew what their care plans said but two said they did not and requested copies of their plans. This was fed back to ward staff during our visit. All the patients we spoke to said they knew how to access the advocacy service and several people gave us examples of how the advocate was supporting them.

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.