Kemple View

Ratings - Forensic inpatient or secure wards

• Overall

  Good

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Good

Our view of the service

At this assessment we identified the following breach of regulation:

Forensics service

• Regulation 15 - Premises and Equipment - some areas of the service were not clean, and areas of the environment were not safe or comfortable for patients.

  However:

• The service had sufficient staff who met the individual needs of patients, managed risk and supported patients to make decision about their care and treatment.
• The service offered a range of psychological therapies which were tailored to the needs of each individual patient.
• There was a range of activities and educational and volunteering opportunities that patients could access.
• There was a strong focus on patient inclusion and staff encouraged patients to become involved in co-production activities that influenced the running of the service.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. 99% of staff had received up to date training in the Mental Health Act.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had a range of relevant policies and procedures relating to different aspects of the Mental Health Act, however, some of the policies were out of date.
• Patients had easy access to information about independent mental health advocacy.
• Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.
• Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. 98% of staff had received training in the Mental Capacity Act.
• The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.
• Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.
• Staff took all practical steps to enable patients to make their own decisions.
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. Staff regularly reviewed and updated capacity assessments.
• When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person's wishes, feelings, culture and history.
• The service had arrangements to monitor adherence to the Mental Capacity Act.
• Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

People's experience of this service

We spoke with 12 patients and 2 carers, we also received feedback from 6 commissioners. We attended a patient feedback meeting and reviewed patient feedback gathered by the provider through surveys and meeting minutes. 

Patients told us they felt safe on the wards. Patients mostly told us that staff were supportive, we were told that staff were brilliant, that they explained things well to patients and that they were very good at dealing with incidents. However, patients on Elmhurst ward told us they felt less supported by the night staff. Several patients also told us they had difficult relationships with the Multi- disciplinary Team, for example patients did not feel they were responsive to concerns around medication and that this was not dealt with in a timely way. 

Patients told us there was a lot to do on the wards, and specifically mentioned music nights, working in the garden and playing football. Most but not all patients told us they had a copy of their care plans. Patients told us they knew how to complain, and we observed a community meeting where patients raised concerns they had about the ward, patients were all involved in the meeting and felt listened to. We reviewed previous meeting minutes and found that patient concerns were mostly resolved. 

Carers were positive about the service; they told us staff were caring and polite and that their loved ones felt safe on the wards. 

Commissioners told us, managers and staff worked with them in an open and transparent way and were responsive to any concerns they had. They shared that patients told them they felt safe at the hospital and that there were good mechanisms for including patients and ensuring their voice was heard.