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St Andrew's Healthcare - Mens Service Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 September 2019

We did not rate this service.

We carried out this inspection in response to concerning information received through our monitoring processes.

We found the following areas the provider needs to improve:

  • Managers had not ensured safe and clean environments. The ward was dirty, cluttered, poorly maintained and in need of redecoration. Staff did not always follow infection control principles. Managers had not ensured the review of ligature assessments in line with the provider’s policy. We observed a patient using an area on their own, that managers assessed as requiring staff supervision to mitigate against identified ligature risks. However, on a return visit the provider had deep cleaned and de-cluttered the ward.
  • Patients did not have direct access to outside space. Whilst the ward had a garden area allocated, this was located away from the ward and was not easily accessible. Facilities did not meet patient needs; disabled facilities were not easily accessible.
  • Leaders and governance arrangements did not assure the delivery of high quality care. Leaders had been planning to move the ward to more suitable premises for over a year. Senior managers had not ensured that the ward environment was safe and clean and were focused on moving the ward at the expense of ensuring the quality of the ward environment was acceptable. We were concerned that the provider had been aware of these issues for a significant period of time and the ward continued to be an unpleasant environment for patients and staff. There was no clear model of service, the provider described the service as ‘locked rehab’, the service was registered as a ward for older people with mental health problems and senior managers told us the service provided ‘specialised nursing’.

However, we found the following areas of good practice:

  • The provider had made improvements to fire safety and medicines management following the last inspection and Mental Health Act review visit.
  • The provider had agreed actions to improve the environment of the ward and completed a deep clean and de-clutter and stopped using the laundry room as a kitchen between our visits.
Inspection areas

Safe

Requires improvement

Updated 20 September 2019

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Managers had not ensured safe and clean environments. The ward was dirty, cluttered, poorly maintained and in need of redecoration. Furniture was worn out, the carpet throughout the ward was stained and dirty, the ward smelt strongly of urine and the light in one of the shower rooms was not working. We noted that a vacuum cleaner was left in the lounge area, the foyer was used to store equipment and the equipment storage room was cluttered and untidy. Staff did not always follow infection control principles; the ward had a room that staff and patients used as an activity kitchen and a laundry room and we observed that staff did not clean chairs used by a patient incontinent of urine. However, on a return visit the provider had deep cleaned and de-cluttered the ward and the laundry room was no longer used as a kitchen.
  • Managers had not ensured the review of ligature assessments in line with the provider’s policy. Managers were due to review the ligature risk assessment in June 2019. However, following our visit we were provided with a copy of a risk assessment completed on 25 July 2019. We observed patients using an area unsupervised, that managers assessed as requiring staff supervision to mitigate against identified ligature risks.
  • Staff did not follow the provider’s security procedures. Staff left their personal bags in the sluice room, the cleaning cupboard and in the office.

However:

  • The provider made improvements to fire safety since the last inspection by updating ward fire procedures, creating personal emergency evacuation plans for all patients, organising fire safety training and fitting an evacuation chair, for moving patients with limited mobility down stairs in the event of a fire.
  • The provider addressed an action point issued by the CQC Mental Health Act reviewer in relation to T3 forms being out of date. A T3 form is a second opinion certificate required when a patient does not have capacity to consent or refuses to consent to treatment. On the day of our visit the T3 forms were all in date. The provider advised that they had set up a new system to archive old T3 forms and reviewed the T3 folder in weekly ward rounds to ensure forms were up to date.

Effective

Good

Updated 20 September 2019

Caring

Good

Updated 20 September 2019

Responsive

Requires improvement

Updated 20 September 2019

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Patients did not have direct access to outside space. Whilst the ward had a garden area allocated, this was located away from the ward and was not easily accessible. At the time of our visit only three of the 15 patients had unescorted leave. The remaining patients were reliant on staff to escort them to access outside space. Staff told us that they encouraged and supported patients to get outside two to three times a day.
  • Disabled facilities were not easily accessible. The disabled toilet and bathing facilities were located at the end of the ward, a long distance away from the main communal area. We were concerned that it was a long way for a patient with limited mobility to travel to use the toilet.

Well-led

Requires improvement

Updated 20 September 2019

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Leaders and governance arrangements did not assure the delivery of high quality care. Leaders had been planning to move the ward to more suitable premises for over a year. Senior managers had not ensured that the ward environment was safe and clean and were focused on moving the ward at the expense of ensuring the quality of the ward environment was acceptable. Staff told us that they felt forgotten about and had given up on the idea of the ward being moved. We were concerned that the provider had been aware of these issues for a significant period of time and the ward continued to be an unpleasant environment for patients and staff.
  • There was no clear model of service, the provider described the service as ‘locked rehab’, the service was registered as a ward for older people with mental health problems and senior managers told us the service provided ‘specialised nursing’.

However:

  • Senior managers told us they had discussed Foster ward at a meeting two days prior to our visit and immediate remedial actions had been agreed to improve the environment. On our return visit, the following week, the provider had completed some of these actions.
Checks on specific services

Child and adolescent mental health wards

Good

Updated 16 September 2016

  • Bayley ward is a medium secure inpatient ward that can accommodate up to 10 children and adolescent males with learning+ disabilities / autistic spectrum disorder.

  • Heygate ward is a medium secure inpatient ward that can accommodate up to 10 children and adolescent males with learning disabilities / autistic spectrum disorder.

  • Fenwick ward is a low secure inpatient ward that can accommodate up to 10 children and adolescents females with neuro-disability / autistic spectrum disorder.

  • Richmond Watson ward is a low secure inpatient ward that can accommodate up to 12 children and adolescent males with complex mental health needs.

  • Church ward is a low secure inpatient ward that can accommodate up to 10 children and adolescent males with neuro-disability / autistic spectrum disorder.

  • Boardman ward is a low secure inpatient ward that can accommodate up to 11 children and adolescent females with complex mental health needs.

  • Heritage ward is a low secure inpatient ward that can accommodate up to 12 children and adolescent females with complex mental health needs.

  • John Clare ward is a low secure inpatient ward that can accommodate up to nine children and adolescent females with complex mental health needs.

Services for people with acquired brain injury

Good

Updated 16 September 2016

  • Rose ward is a medium secure male ward.

  • Tallis, Tavener, Althorp, Berkeley Close (1st floor) are male locked wards.

  • Berkeley Close (ground floor) is a female locked ward.

  • Berkeley Lodge, 37 and 38 Berkeley Close and 19 The Avenue are locked units

  • Walton is for male patients with Huntingdon’s disease.

  • Harper – specialist ward for male and female patients with Huntingdon’s disease.

Wards for people with a learning disability or autism

Requires improvement

Updated 6 June 2018

Hawkins ward

Naseby ward

Mackaness ward

Harlestone ward

Watkins House

Garden Cottage

Forensic inpatient or secure wards

Requires improvement

Updated 6 June 2018

Robinson ward

Fairbairn ward

Prichard ward

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 6 June 2018

Ashby ward

Fenwick ward

Church ward

Wards for older people with mental health problems

Requires improvement

Updated 20 September 2019

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 6 June 2018

Heygate ward