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The Billingham Grange Independent Hospital Outstanding


Inspection carried out on 23rd and 24th April 2018

During a routine inspection

We rated The Billingham Grange Independent Hospital as outstanding because;

  • Staff displayed a caring and compassionate approach to patients. Staff knew patients they cared for well and ensured that the support they gave was in line with their personal preferences.
  • There was a strong governance structure in place, which displayed joined up working from ward to board level. The service was very well-led at ward and regional level. Staff and patients told us the hospital director was approachable and supportive. The company had clear vision and values which were clearly embedded in the running of the service. Values were demonstrated by staff who cared for patients in a kind and compassionate manner.
  • Staff went the extra mile to ensure that patients were involved in decisions about their care and treatment. Staff made multiple attempts to engage patients and used different methods to help patients make choices. Where appropriate there was evidence of families being involved in decisions about care.
  • Patients, families and carers participated in the formulation of care plans. Where people were reluctant to participate, they were encouraged by staff. Patients were involved in planning for discharge. Discharge planning was embedded in care delivery and was discussed in multi-disciplinary meetings and ward rounds.
  • Patients who lacked capacity were automatically referred to independent advocacy services. Contact details for advocacy services were displayed throughout the service. Patients were supported and encouraged to access services in line with the Mental Health Act Code of Practice

  • Staff encouraged and supported patients to access health screening tests. There was a registered general nurse on each ward to monitor the physical health of patients. Staff used recognised screening tools to help them monitor various aspects of physical health.
  • All patients had a named nurse and secondary nurse. Photographs of named nurses were in patient’s bedrooms to help them remember who the named nurse was. Patients had regular one to one time with their named nurse.
  • There was minimal use of restraint and this was only used after verbal de-escalation had been attempted. Restraint was kept to low level holds and patients were given de-briefs following incidents.
  • The provider kept staff, patients and visitors up to date with the running of the service and ratings from previous CQC inspections were posted in the hospital to ensure people could see them.
  • Patients and carers were encouraged to give their feedback on the service and the care and treatment they received. The service had been proactive in capturing and responding to patients concerns and complaints.
  • There was a good and varied activities programme which provided patients with activities seven days per week. There were a range of activities which helped with patients’ physical and mental health and fitness.
  • Poor performance was identified and dealt with quickly and effectively. There was clear learning from incidents and lessons learned were shared both during clinical governance meetings and with staff from national Barchester Healthcare services. This helped to prevent recurrences of incidents.

Inspection carried out on 9 May 2016

During an inspection to make sure that the improvements required had been made

We rated Billingham Grange Independent Hospital as good because:

  • Individual risk assessments were carried out and regularly reviewed. Ligature risks had been assessed and steps had been taken to mitigate these risks.
  • Mandatory training at the hospital was at 88%, which was above the providers’ requirement of 85%.
  • Staff employed at the hospital had undergone checks to ensure they were suitable for the role.

Investigations were carried out following incidents and lessons learned were fed back to staff.

Inspection carried out on 3 and 4 September 2015

During a routine inspection

We rated The Billingham Grange Independent Hospital as good because:

  • Patients spoken with gave positive feedback on staff. They said staff treated them with dignity and respect, and were caring. Mental Health Act documentation was clearly recorded and up to date and records showed that patients’ rights and status under the Act were explained to them.
  • Patients’ needs were assessed before and on admission, including physical assessments, which were reviewed regularly. Twelve out of the14 records that we reviewed had good up to date risk assessments. Care plans were holistic and reviewed regularly.
  • Staff had assessed the risks posed by fixtures and fittings that patients at risk of suicide could use to attach a ligature. A ligature point is a place where a patient intent on self-harm might tie something to strangle themselves.
  • The clinical workforce included a range of allied professionals dedicated to each ward. All staff felt supported by managers and had access to supervision. A total of 88% of staff had completed their mandatory training which was above the requirement of 85% set by the provider. Clinical governance systems, which included a range of audits and checks, helped the service provider to monitor and improve the quality of care.

But we also found:

  • The hospital did not always manage medicines safely by following its medicines management policy. Nurses routinely wrote and transcribed prescription sheets and not all of these medications had been countersigned by either a doctor or a nurse prescriber. This potentially could put patients at risk of receiving incorrect medication. Staff did not always follow infection control principles when giving medication and were reusing single use medicine pots which also exposed patients to unnecessary risks
  • There was limited evidence of patient involvement in care plans and none of the records reviewed indicated patients had received a copy of their care plan.
  • Although all staff could tell us how they kept patients safe from the risk of harming themselves, not all support staff understood what a ligature point was and the risks associated with them. There was no central risk register or log to provide an overview of identified risks and actions taken to manage or eliminate them.
  • Managers’ understanding of the organisations vision and values were mixed.

Inspection carried out on 29 May 2013

During a routine inspection

We decided to visit the home late evening and through the night to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

We spoke with six people who used the service, 11 different grades of staff and the manager. We also observed the interaction between staff and people who used the service.

We found that where people were detained under the Mental Health Act, appropriate systems were in place which ensured that the service worked within the legal frameworks.

We spoke with six patients and observed the staff practice on the units. Patients told us that they were happy with the care they were receiving and thought highly of the staff. One patient said, “The staff are very, very good and nothing is a bother.” Most patients were unable to make extensive comments about their care due to their limited speech but non-verbally indicated that they were happy with the care. From observations we found staff understood patients care needs and consistently worked in a person-centred manner.

We found there were good systems in place for working with other health and care professionals.

We found there were good systems in place for monitoring the quality of the service and service delivery.

Inspection carried out on 5 November 2012

During a routine inspection

This inspection was conducted by three compliance inspectors and a Mental Health Act Commissioner. We used this approach, as some concerns had been received about care and welfare of the people who used the service. The issues centred around the staff ability to support people with complex needs. We spoke with a range of staff and at least two people on each unit. A large number of people living at the service were unable to verbally communicate with us. Throughout the inspection we observed people being treated kindly and with respect and being encouraged to make choices in regard to their daily lifestyles.

People said “It’s alright here”, “I like the staff”, “I would like a bit more freedom as I could get back without getting lost” and “I go out with staff all the time”. One person stated they, "Loved it" and "It the best place ever".

We found that since the previous inspection the care records had been improved and information was more accessible. We found that where people were detained under the Mental Health Act this had been done within the correct legal frameworks.

Improvements had been made to environment since the last inspection, this continued to be ongoing. Emergency equipment and procedures had been reviewed and appropriate training, checks and systems were seen to be in place. People's needs were being met by a staff team, with sufficient skill mix, knowledge and understanding.

Inspection carried out on 21 March 2012

During an inspection to make sure that the improvements required had been made

We spoke with people about the care they were receiving. One person was extremely positive about this. They said, "Well supported by the staff. There is enough going on, I can go out, like to watch TV and DVD's."

One person said they were not happy, which was discussed fully with them and a senior member of staff, who agreed to have further discussion with the person. They were aware of their legal rights and the constraints this placed upon them.

People spoken with generally felt well supported by the staff team. One person said, "I have been here for five years and feel well supported by the staff."

Inspection carried out on 3 October 2011

During an inspection in response to concerns

We did not seek the views of people using the service on this occasion.

Inspection carried out on 28 July 2011

During a routine inspection

People we spoke to told us they had been fully involved in the process of assessing their needs and developing their care plans. They talked of an inclusive environment in which they were well able to express views about their care and daily life. One person said, "Named nurse discussed my assessment and care needs with me. Yes I have discussed my care plan with named nurse and have a copy of it as well as a copy of the Mental Health Act guide. I am aware of my mental health act status and my rights have been discussed".

People were positive about the care provided at The Billingham Grange. One person spoken to confirmed that they received the care they needed. They said, "I think I get the care and support needed at the moment, I am fully aware of my care management plan and medication regime. I can express my views and influence changes to care plan".

Another person said, "I get the care I need and am treated with respect".

People spoken to told us they felt safe living at The Billingham Grange.

They said, "I get the care I need and am treated with respect. I feel safe living here. I would talk to the staff if I was worried about something, but I haven’t had to do this. I don’t know how to make a complaint, but I would talk to staff if I wanted to make one".

They were also well aware of who to speak to should they have any worries or concerns.

They were fully aware of their legal rights under the Mental Health Act, confirmed they had been read their rights and had supporting documentation.

People were very positive about the staff who care and support them. They said, "I love the staff here, it is the way they support me". "All staff are lovely, it is calm, they talk to me and comfort me, they make me feel wanted, dead kind and dead nice".

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.