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St Andrew's Healthcare - Neuropsychiatry Service Good

Inspection Summary


Overall summary & rating

Good

Updated 7 August 2017

We rated wards for older people with mental health problems as good because:

  • Patients received timely access to physical healthcare, including access to specialists when needed.
  • Care records were up to date and included the patients personalised life story “This is me.” Care records showed positive behaviour plans and support.
  • Technology and equipment were used to enhance delivery of care, for example a talking tile (which had a picture of patient’s family member and a recorded message) and a digital aquarium on the wall for patient‘s viewing. Staff accessed video calls for patients to see and speak with their carers and relatives. One patient spoke regularly with their relative abroad.
  • Staff received the necessary specialist training for their role for example end of life training, dementia care mapping, and physical health care training.
  • Staff were supervised with one to one meetings, group reflective practice meetings, appraised and had access to regular team meetings.
  • We observed effective early morning handovers on O’Connell South and Compton wards.
  • Staff participated in regular clinical audits such as infection control, cleanliness audit. Clinicians were provided with research evidence from recent publications via alerts.
  • Staff told us managers were supportive, and were a visible presence on the ward. Staff knew how to use the whistle blowing process.
  • • The clinical nurse lead on O’Connell South ward was the champion for the staff survey, encouraging staff to complete the survey “My Voice”.
  • O’Connell North and South wards were working towards accreditation for the quality network older adults. An application had been submitted.

However:

  • On O’Connell South ward, the visitor’s room on the first floor had two large sash windows with no restrictors. These meant widows could be fully opened and patients may not be safe when left unsupervised in this area. When we brought this to the attention of the clinical nurse lead they told us repairs would be made to the windows within three days. The door was locked after we brought the issue to their attention.
  • The patients lift on the first floor of O’Connell South ward was not in use for one week. This was due to an infection control outbreak on an adjacent ward. We saw the lift was unclean with litter, and reported this to the clinical nurse lead. The lift was immediately cleaned. For a temporary period O’Connell South ward was accessed via another lift in the building. 
Inspection areas

Safe

Good

Updated 7 August 2017

Following our inspection in June 2016 we rated the services as good for safe. We did not inspect this key question on this inspection.

However we found the following:

  • On O’Connell South ward, the visitor’s room on the first floor had two large sash windows with no restrictors. These meant windows could be fully opened and patients may not be safe when left unsupervised in this area. The clinical nurse lead told us repairs would be made to the windows within three days. The door was locked after we brought this to their attention.

  • The patients lift on the first floor of O’Connell South ward was not in use for one week.This was due to an infection control outbreak on an adjacent ward. We saw the lift was unclean with litter, and reported this to the clinical nurse lead. The lift was immediately cleaned. For a temporary period O’Connell South ward was accessed via another lift in the building.

Effective

Good

Updated 7 August 2017

We rated effective as good because:

  • Patients received timely access to healthcare, including access to specialists when needed.

  • Care records were up to date and included the patients personalised life story “This is me.” Care records contained positive behaviour plans and support.

  • Technology and equipment were used to enhance delivery of care, for example a talking tile (which had a picture of patients family member and a recorded message) and a digital aquarium on the wall for patient‘s viewing.Staff accessed video calls for patients to see and speak with their carers and relatives. One patient spoke regularly with their relative abroad.

  • Staff received the necessary specialist training for their role for example, end of life training, dementia mapping and physical health care training.

  • Staff were supervised with one to one meetings, reflective group meetings, appraised and had access to regular team meetings.

  • We observed effective early morning handovers on O’Connell and Compton wards.

Caring

Good

Updated 7 August 2017

Following our inspection in June 2016 we rated the services as good for caring. Since that inspection we have received no information that would cause us to re-inspect these key questions or change the ratings.

Responsive

Good

Updated 7 August 2017

Following our inspection in June 2016 we rated the services as good for responsive. Since that inspection we have received no information that would cause us to re-inspect these key questions or change the ratings.

Well-led

Good

Updated 7 August 2017

We rated well-led as good because:

  • There were governance processes in place to monitor quality, performance and take appropriate action following serious incidents.

  • Staff participated in regular clinical audits such as infection control, cleanliness audit.

  • Staff told us managers were supportive, and were a visible presence on the ward.

  • Staff spoke passionately about the patient group. There was a culture of high quality sustainable care, which was corroborated with staff interactions with patients and care records.

  • Staff knew how to use the whistleblowing process.

  • The clinical nurse lead on O’Connell South ward was the champion for the staff survey, encouraging staff to complete the survey- My Voice.

  • O’Connell North and South wards were working towards accreditation for the quality network older adults. An application had been submitted.

Checks on specific services

Child and adolescent mental health wards

Requires improvement

Updated 10 February 2015

  • There was a need to assess and treat patients based on individual risk and identified needs, rather than placing emphasis on generic, restrictive risk management processes.
  • Agency and bank staff did not have adequate information about individual patient care and any safeguarding protection plans on the wards where they are working.
  • The complaints process was not always clearly displayed on the wards in formats people can understand.
  • Feedback from the outcome of complaints was not shared with the complainant on all occasions. 
  • Seclusion facilities were being used for de-escalation and time out.

Wards for people with learning disabilities or autism

Requires improvement

Updated 10 February 2015

  • The information about the complaints process was not clearly displayed on the wards in formats people can understand.
  • Agency and bank staff did not always have adequate information about individual patient care.
  • Seclusion facilities were being used for de-escalation and time out.
  • Not all of the staff could demonstrate an understanding about appropriate use of the seclusion facilities.
  • The CQC have not been sent notifications relating to incidents affecting service or the people who use it, in line with requirements.
  • Not all wards had resuscitation equipment. There were a number of locked doors, stairs and potentially an unpredictable patient group, which may impact how quickly the equipment arrived where it was needed. The provider must ensure that lifesaving equipment is available without delay.

Forensic inpatient or secure wards

Requires improvement

Updated 10 February 2015

  • Patient’s views were not always documented in care plans
  • On Fairbairn ward there were not always staff available who were trained in British Sign Language.
  • Patient reviews of restraint and seclusion were not always being undertaken and documented fully
  • Not all of patients are assisted to understand their rights
  • Not all medication administration is accurately recorded.
  • All paperwork was of high standard including that for the Mental Health Act.
  • Reviews of care within the multi-disciplinary team were thorough and capacity was assessed regularly.
  • Within in the Women’s service, the documentation of restraint and seclusion was detailed with timings and we saw learning from incidents had occurred

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

Good

Updated 10 February 2015

  • We observed and staff reported good and supportive multi-disciplinary team working.
  • Additional systems were in place to review enhanced support and seclusion/segregation, such as arranging for doctors across wards to give a second opinion/ independent review on the management of these incidents.
  • Robust systems were in place for the management and auditing of medicines.
  • We found that the monthly patient safety and experience group held at St Andrew’s Healthcare Essex was an effective forum for managing and learning from patient safety incidents that took place in the hospital.
  • We identified good examples of the provider supporting staff to attend additional training to prepare them to care for people with specific mental healthcare needs.

Wards for older people with mental health problems

Good

Updated 7 August 2017

O’Connell North ward

O’Connell South ward

Compton ward

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

Good

Updated 16 September 2016

  • Hawkins is medium secure ward for men with learning disabilities (LD).

  • Sitwell is a medium secure ward for women with LD.

  • Naseby is a low secure ward for men with LD.

  • Spencer North is a low secure ward for women with LD.

  • Mackaness is a male medium secure ward for people with ASD.

  • Harlestone is a male low secure ward for people with

    ASD.

Forensic inpatient or secure wards

Requires improvement

Updated 16 September 2016

  • Seacole Ward is a medium secure ward for women.

  • Stowe Ward is a medium secure ward for women.

  • Sunley ward is a medium secure ward for women.

  • Elgar ward is a low secure ward for women.

  • Spencer South is a low secure ward for women.

  • Sinclair ward is a low secure ward for women.

  • Robinson ward is a medium secure ward for men.

  • Fairbairn is a medium secure ward for men with hearing difficulties.

  • Prichard ward is a medium secure ward for men.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 16 September 2016

  • Thornton ward is a locked rehabilitation unit for women.

  • Ferguson ward is a locked rehabilitation unit for men.

  • Spring Hill House is a locked facility rehabilitation unit for Women offering 23 beds.

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

Requires improvement

Updated 16 September 2016

  • Sherwood ward is the psychiatric intensive care unit.