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

Ellern Mede Derby

Overall: Requires improvement read more about inspection ratings

96 Draycott Road, Breaston, Derby, Derbyshire, DE72 3DB (020) 3209 7900

Provided and run by:
Oak Tree Forest Limited

All Inspections

07 November 2023 and 08 November 2023

During an inspection looking at part of the service

Our rating of this location went down. We rated it as requires improvement because:

  • The service had a clear and detailed treatment model in place but staff did not complete appropriate, regular physical health checks and document detailed treatment plans in line clinical guidance and the service model.
  • The service had high healthcare assistant vacancy rates and a reliance on temporary agency staff.
  • Staff did not complete post incident checks, including neurological observations of young people and body maps when young people had sustained injuries.
  • The service did not always complete patient searches and log these in line with the service policy after a young person had taken leave, increasing the risk of items being secreted onto the ward area.
  • Care planning documentation did not always give a detailed rationale around the treatment plan prescribed for young people, particularly around physical health needs and mental state for young people who were at a healthy weight for their height.
  • Young people did not have adequate storage for their belongings and staff did not manage items of potential risk safely, increasing the risk of young people’s belongings being lost or a potential safety incident occurring.
  • Governance processes did not always ensure that ward procedures ran smoothly. The processes in place did not always identify gaps in post incident checks, gaps in young people’s physical health checks and gaps in young people’s care planning.

However:

  • The ward environments were safe and clean. The wards had enough nurses and doctors to keep people safe.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
  • The service delivered tailored training specific to the service.
  • Staff felt listened to and able to influence service delivery. Staff spoke positively about the service and were proud of their work and enjoyed their role.
  • The service provided psychological therapies in line with national guidance.

1 to 2 February 2023

During a routine inspection

We rated it as good because:

  • The service provided safe care. The service had enough nursing and medical staff, but not enough permanent healthcare assistants to meet the needs of young people. The ward environments were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Most staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the young people and in line with national guidance and best practice. The service provided young people with opportunities for regular exercise and activities. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to a range of specialists required to meet the needs of young people on the ward. Managers ensured that most staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare. Young people attended multidisciplinary meetings and had a voice in their care.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. The service followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • Staff treated young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of young people. They actively involved young people and families and carers in care decisions.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly. The service had developed leaflets and communications aimed at young people and parents and carers.

However:

  • The hospital had high healthcare assistant vacancy rates and a reliance on temporary agency staff.
  • Not all staff were up to date with mandatory training topics. Three of the mandatory training topics fell below the service target rate of 90%: Immediate life support and fire compliance both 82% and manual handling 89%.
  • One care plan for managing restrictive interventions during mealtimes and refeeding did not include young peoples’ wishes.
  • Not all staff had received regular supervision with a 77% compliance, the service target rate was 90%.
  • Some front-line staff told us they felt levels of distress when restraining young people during mealtimes/ refeeding which impacted their wellbeing and staff morale.