You are here

St Andrew's Healthcare - Essex Good

We are carrying out a review of quality at St Andrew's Healthcare - Essex. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Good

Updated 18 September 2017

We rated St Andrew’s Essex as good because:

  • All ward areas were clean and well maintained; equipment was well maintained and safety tested, cleaning records were up to date and demonstrated regular cleaning of ward areas.

  • There were designated quiet areas on all wards and there was a visitor’s room near the hospital entrance that could be used for patients to meet with family and friends.
  • There was a phone room on all wards to facilitate patients making calls in private.
  • Patients were given a welcome pack on the psychiatric intensive care wards, which contained essential items for hygiene and enhanced their wellbeing.
  • Shifts were covered by sufficient numbers of staff with the right grades and experience.
  • Staff told us that morale had improved recently and attributed this to new members of the leadership team.
  • Staff told us they felt well supported by managers.
  • There were flexible working arrangements available for staff.
  • Staff and visitors had access to personal alarms. The provider had simplified their staff recording system since the last inspection and for the majority of shifts; staffing numbers matched those on the rota. Shifts were covered by sufficient numbers of staff with the right grades and experience. Staff told us that they were able to maximise their time on direct care activities as opposed to administration duties. There was a full range of mental health professionals available to deliver care.
  • Staff we spoke with knew what incidents to report and used electronic recording system to report incidents. Staff were open and transparent and explained to patients when things went wrong. Staff told us they received feedback from investigation of incidents at team meetings and in managerial supervision. There was evidence that changes had been made as a result of feedback.
  • Patients we spoke with told us staff were kind and treated them with dignity and respect. Carers we spoke with told us that they were pleased with the care their relative received.
  • Care records were up to date, personalised, with holistic recovery-orientated care plans.
  • Prescription charts showed that staff followed National Institute for Health and Care Excellence guidance for prescribing medication. The pharmacist had written the percentage of medication prescribed to help staff remain within British National Formulary limits and reduce the risk of multiple medications being prescribed for the same problem.

However we found the following areas that the provider needs to improve:

  • There were high levels of the use of prone restraint across the hospital, particularly in the psychiatric intensive care services. Whilst the provider had set out measures to reduce levels of seclusion and restraint these measures had not yet had significant effect.
  • The external door to the garden from the extra care suite on Audley ward was clear glass and therefore visible from the garden. This compromised patients’ privacy and dignity. This was raised with the provider who agreed to address the issue.
  • The fridge lock in the clinical room on Audley ward had been broken. The provider had sourced a new lock and was awaiting fitting of the new lock at the time of the inspection.

  • For two of the seclusion records reviewed the front sheets were incomplete. The nurse in charge had not signed them before uploading to the electronic record.
  • For one patient the gap between medical reviews whilst in seclusion was longer than the four hours recommended by the Mental Health Act 1983: Code of Practice.
Inspection areas

Safe

Requires improvement

Updated 18 September 2017

We rated safe as requires improvement because:

  • The fridge lock in the clinical room on Audley ward had been broken. The provider had sourced a new lock and was awaiting fitting of the new lock at the time of the inspection.

  • There were high levels of the use of prone restraint across the hospital, particularly in the psychiatric intensive care services. Whilst the provider had set out measures to reduce levels of seclusion and restraint these measures had not yet had significant effect.

However we found the following areas of good practice:

  • Wards were laid out in a way which allowed staff to observe all areas of the ward. The provider had installed mirrors where staff did not have clear lines of sight.

  • The wards complied with guidance on same sex accommodation.

  • Clinic rooms on all four wards were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

  • The seclusion rooms met the guidelines contained in the Mental Health Act Code of Practice.

  • All ward areas were clean and well maintained; equipment was well maintained and safety tested, cleaning records were up to date and demonstrated regular cleaning of ward areas.

  • Staff and visitors had access to personal alarms.

  • The provider had simplified their staff recording system since the last inspection and for the majority of shifts; staffing numbers matched those on the rota.

  • The provider had a shift coordinator for the hospital who was able to adjust the staffing levels on a daily basis to take account of case mix and need on the ward.

  • The majority of staff were up to date with their mandatory training.

  • Staff we spoke with knew what incidents to report and used the electronic recording system to report incidents. Staff were open and transparent and explained to patients when things went wrong. Staff told us they received feedback from investigation of incidents at team meetings and in managerial supervision. There was evidence that changes had been made as a result of feedback. Staff were offered a debrief after serious incidents.

  • Ninety per cent of staff had completed mandatory training and were also able to access specialist training.  Managers had released several staff to complete their dialectical behaviour therapy training.

Effective

Good

Updated 18 September 2017

We rated effective as good because:

  • Care records showed that physical examination had been undertaken and that there was on-going monitoring of physical health problems. There was access to physical healthcare including access to specialist care at the local hospital when needed.

  • Care records were up to date and personalised with holistic, recovery-orientated care plans.

  • Prescription charts showed that staff followed National Institute for Health and Care Excellence guidance for prescribing medication. The pharmacist had written the percentage of medication prescribed to help staff remain within British National Formulary limits and reduce the risk of multiple medications being prescribed for the same problem.

  • Both psychiatric intensive care wards offered psychological interventions recommended by National Institute for Health and Care Excellence. Personal behavioural support plans were based on dialectical behaviour therapy.

  • There was a full range of mental health disciplines available to deliver care including nurses, psychologists, occupational therapists, social workers, consultant psychiatrists, associate specialists, dieticians, technical instructors, health care assistants and pharmacists.

  • There were regular multidisciplinary meetings on all wards. We observed two handover meetings and saw that handovers covered risk levels, observations and an overview of the patient’s presentation.

Caring

Good

Updated 18 September 2017

We rated caring as good because:

Following our inspection in September 2016, we rated the services as good for caring. Since that inspection we have received no information that would cause us to re-inspect this key question or change the rating.

Responsive

Good

Updated 18 September 2017

We rated responsive as good because:

  • There was a full range of rooms and equipment to support treatment and care. On Danbury ward the provider had commissioned works to create a games, therapy and meeting room.

  • There were designated quiet areas on all wards and there was a visitor’s room near the hospital entrance that could be used for patients to meet with family and friends.

  • There was a phone room on all wards to facilitate patients making calls in private.

  • Patients were given a welcome pack on the psychiatric intensive care wards, which contained essential items for hygiene and enhanced their wellbeing.

  • Each ward had its own designated outside space. Patients had access to fresh air at regular intervals throughout the day.

  • There were facilities for patients requiring assisted access to bathroom facilities.

  • There was a range of information in leaflet and poster form on all wards about treatment objectives, patients’ rights, how to complain and access to advocacy services. Staff told us they could easily access information in other languages should they need to.

  • Staff told us they could access interpreters if necessary.

  • The catering team provided access to a range of foods to meet dietary requirements including those required to meet religious or cultural needs.

  • The hospital had access to a chaplain who had links to other faith leaders in the local community. The hospital had a multi-faith room with adjoining washing facility where people could wash their hands and feet before prayer.

However we found the following area that the provider needs to improve:

  • The external door to the garden from the extra care suite on Audley ward had a clear glass panel and therefore the area was visible from the garden. This compromised patients’ privacy and dignity. This was raised with the provider who agreed to resolve the issue.

Well-led

Good

Updated 18 September 2017

We rated well-led as good because:

  • Staff we spoke with knew the organisation’s vision and values and told us they agreed with them. There were posters displaying the vision and values on the wards.

  • Staff we spoke with knew who the most senior managers in the organisation were and felt well supported by them.

  • Managers ensured that staff received mandatory training. Staff were appraised annually and supervised monthly.

  • Shifts were covered by sufficient numbers of staff with the right grades and experience.

  • Staff told us that they were able to maximise their time on direct care activities as opposed to administration duties.

  • The provider did not have a policy for managerial supervision but staff told us that they received managerial supervision.

  • Staff told us that morale had improved recently and attributed this to new members of the leadership team.

  • Staff told us they felt well supported by managers.

  • There were flexible working arrangements available for staff.

  • Staff we spoke with told us that managers supported them to access specialist training.

Checks on specific services

Forensic inpatient or secure wards

Good

Updated 10 February 2015

Overall we found that improvements were required as the services provided were not always safe. Actions from ligature audits were not followed through on one ward and care and treatment records were incomplete in respect of one person’s physical healthcare needs. This meant that people may be at risk of unsafe care and treatment.

There were systems in place to ensure an effective service. Surveys and audits measured the quality and effectiveness of systems.

The services provided were caring. This was confirmed by our observations of the care and treatment being provided and subsequent discussions with staff.

The services provided were responsive. Evidence was seen that demonstrated to us that the provider encouraged feedback from people and staff to influence the running of the service.

The services provided were well led. Most staff told us that they felt supported. Staff across all of the wards inspected told us that there were difficulties with the recruitment and retention of staff. We found that there was widespread use of bureau (St Andrews healthcare staff) and agency staff on the wards inspected.

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

Good

Updated 10 February 2015

Overall we found that PICU services provided safe, effective, caring, responsive and well led services.

We found that risk assessments were carried out to keep people, staff and the environment safe.

There were systems in place to ensure an effective service. Surveys and audits measured the quality and effectiveness of systems.

The services provided were caring. This was confirmed by our observations of the care and treatment being provided and subsequent discussions with staff.

The services provided were responsive. Evidence was seen that demonstrated to us that the provider encouraged feedback from people and staff to influence the running of the service.

The services provided were well led. Most staff told us that they felt supported. Staff across both wards told us that there were difficulties with recruitment and retention of staff. We found that both units used a number of bureau (St Andrew’s healthcare staff) and agency staff to support people.

Forensic inpatient or secure wards

Good

Updated 18 September 2017

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

Good

Updated 18 September 2017