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

Stockton Hall

Overall: Requires improvement read more about inspection ratings

The Village, Stockton-on-the-Forest, York, North Yorkshire, YO32 9UN (01904) 400500

Provided and run by:
Partnerships in Care Limited

All Inspections

31 May, 1 and 2 June 2023

During a routine inspection

Our rating of this location stayed the same. We rated it as requires improvement because:

  • Some ward areas were not well maintained, well-furnished or fit for purpose. The condition of the wards was not conducive to a therapeutic environment for patients. Most wards had areas requiring updating and furniture that required replacement. The alarm system on most wards was too sensitive, resulting in false alarms.

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  • Some seclusion rooms were not fit for purpose. Five out of 9 seclusion rooms we looked at still had no en-suite facilities, so patients had to wait for staff members to take them to an adjacent toilet room. Staff had offered bed pans to patients on Kyme ward or to high-risk patients who could not be taken to an adjacent toilet. Damage incurred to the seclusion room on Kyme ward two weeks prior to our visit, however, we were shown evidence that parts and materials had been ordered to enable the necessary repairs to be completed by the end of July 2023. On Dalby and Kyme wards, there was a lack of natural light in the seclusion rooms and the intercom system on Stonegate ward was faulty.

  • Clinic rooms were not always fully equipped or well-maintained. A blood monitoring machine on Stonegate ward had not been subject to quality control since September 2018. The medicines trolley on Kyme ward had not been cleaned and there was a spillage in the medicines fridge.

  • The service did not have enough nursing and support staff and staff turnover within the service was high. This had led to patients' activities and Section 17 leave being cancelled at short notice.

  • The service's medicines management arrangements were not effective. Insulin had not been labelled to show which patient it related to and, 2 glucose tests had expired in July 2022. On Kirby ward, medicine dispensed in the clinic room had been left there unattended.

  • There was no evidence of stool monitoring for a patient on clozapine, an antipsychotic medicine known to cause constipation.

  • We found issues in 15 out of 19 care records we looked at. These included staff not adequately documenting that patients had access to occupational therapy or psychological input, standard phrases being copied and pasted in care records, out of date or incomplete care plans and no information about 3 patients' strengths.

  • Governance structures were not consistently effective. Processes had failed to identify that staff did not always maintain accurate and up-to-date documentation within care records and blanket restriction registers and medicines management was ineffective within the service. There had been insufficient progress in addressing the environmental issues identified in our inspection in January 2020.

  • We saw 2 instances in which patients underwent a pat-down search with the door wide open which compromised their privacy and dignity.

  • There were limits to spiritual, religious, and cultural support for patients. Multi-faith rooms were sparse in the way of materials, there was no chaplain in post and patients were using their prescribed Section 17 leave to access places of worship in the local community.

  • There were blanket restrictions in place on the ward which were unnecessary. Access to the courtyard and outside spaces at night were dependent on specific circumstances at the time and current staffing arrangements. Access to pool rooms, art rooms and group rooms were restricted because the doors were self-closing with automatic locks, so patients needed a staff member to open them. We found the door to the garden area on Kirby ward was locked and the ward manager told us this was because the grass was being cut but this had already been completed.

  • The service did not always engage with carers and relatives well. Three out of 5 carers we spoke with said they had to make efforts to get updates from staff; there was a lack of communication, and their calls were not always returned. One carer told us on multiple occasions, that they had turned up at the hospital for pre-arranged visits with their loved one and staff were not aware of this. Two carers said they did not know how to complain.

However, we found the following areas of good practice within the service:

  • Staff had the necessary training, skills, and experience to carry out their roles. They were appraised and received supervision. They adhered to the Mental Health Act and Mental Capacity Act, knew how to report incidents, safeguarding concerns and received lessons learned from investigations into these.

  • The teams included or had access to a range of specialists required to meet the needs of patients using the service.

  • Patients told us staff were kind, caring, helpful and supportive towards them.

21 to 23 January 2020

During a routine inspection

Stockton Hall is a 112-bed medium secure hospital that provides treatment for people over 18 with mental health problems, personality disorders, autistic spectrum disorders and learning disabilities.

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Not all ward environments were clean or well maintained. The environmental issues and the way staff managed patients’ bathroom access in seclusion impacted on dignity, and some patients reported that staff spoke to them in an abrupt way.
  • Not all staff were aware of ligature points and measures were not in place to manage blind spots on a number of the wards, which could impact patient safety.
  • Patient autonomy was impacted by multiple blanket restrictions in place on wards. Staff did not apply individualised risk assessments to elements of patient care, such as access to outdoor areas being limited to daylight hours and activity rooms on some wards being locked. The service’s reducing restrictive practice group had not recognised some of the restrictions identified, had not appropriately assessed others and wards had failed to implement agreed actions for others.
  • Staff rotas did not consistently demonstrate that there was an appropriate number or skill mix of staff on shift. Staff were regularly required to work on other wards within the hospital, but these moves were not documented.
  • The quality assurance processes lacked oversight, governance structures were not consistently implemented or effective. Meetings were cancelled; and meeting decisions were not always documented. The service’s auditing processes were not effective in ensuring that staff maintained accurate documentation in relation to multiple aspects of client care, including documentation of their capacity, seclusion and daily care notes.

However:

  • Staff minimised the use of physical interventions and seclusions, generally managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Fenton ward was the first medical facility in the country to be awarded an advanced award by the Autism Accreditation Award Committee and the ward had specialised facilities to support recovery.
  • Most patients reported that staff treated them with kindness, respect and dignity. The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Patients were supported to pursue vocational activities both within the hospital and in the local community; and the hospital had facilities to support patient hobbies, such as a music studio and woodwork room.
  • The service enabled staff to pursue further learning and qualifications; such as radically open dialectical behavioural therapy training. The ward staff worked well together as a multidisciplinary team and with external agencies to meet the needs of patients. Staff planned and managed admissions and discharges well and liaised with services that would provide aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Most staff treated patients with compassion, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

22 to 24 May 2018

During a routine inspection

We rated Stockton Hall requires improvement because:

  • The audit systems in place were not always effective. The audits did not identify the issues we found during the inspection for example in relation to the restrictive practice meetings, discharge planning records, the inconsistent use of systems to record information about the patients and implementation of Priory policies.
  • Patients did not routinely have access to a nurse call system but staff ensured on an individual basis that alarms were in place when required.
  • Patients capacity was not always recorded clearly in the patient files and staff were not always able to find them when asked.
  • Discharge planning was not always recorded clearly recorded in the patient files.
  • The provider had informed the Commission in 2016 they were going to develop the hospital and reduce two wards each with 24 beds to four wards each with 12 beds. The development had not happened yet although the plans are with the planning authorities. The delay in developing the two wards means they are tired and would benefit from being refurbished if the development is not started in the near future.

However:

  • The hospital was clean and equipment was available to assist staff in their role.
  • Managers had an active recruitment programme for staff. All staff were supported in their identified training and development needs. Where bank staff were used they worked on the one ward so that they got to know the patients.
  • Managers effectively planned staffing resources to ensure that staff were available to spend the time required on direct patient care such as escorted leaves and attending hospital appointments.
  • The process for reporting incidents and safeguarding concerns was robust and lessons learned were shared with staff. Although staff were unclear about any recent lessons learnt.
  • Patients had access to different disciplines within the hospital to aid their recovery.
  • Patients were involved in their own care planning and they told us staff were supportive and treated them with respect. They accessed a variety of activities and received support from an independent mental health advocate.
  • There was a robust complaints process and when the hospital was found to be at fault they were honest about their mistakes and how they had put right the issue.
  • The service could meet the diverse needs of patients and accessed specialist services to ensure patients could be fully involved with their care.

To Be Confirmed

During an inspection looking at part of the service

  • On the day of our inspection, there was sufficient and adequately trained and experienced staff available across all wards. The hospital had experienced difficulties with staffing particularly at weekends that affected some wards; however, this had improved across all wards over the past three months.
  • Incidents of low staffing had not affected patient safety. Managers and staff planned staffing to meet patients’ needs and prioritised patient safety and access to Section 17 leave. Staff who were familiar with patients’ needs were present across all wards. Most patients told us there was enough staff and felt safe and most staff said there was usually enough staff to maintain safe patient care.
  • Staff completed patient records that demonstrated good practice and kept them up to date. The overall compliance rate for staff training, appraisal, and supervision was high and most staff told us they were able to take regular breaks when they needed them.
  • Staff vacancies at the hospital remained high but managers had an active recruitment and retention programme to make improvements in staffing.

However,

  • Boston ward had experienced more staffing difficulties than others and overall reported the highest number of serious incidents, seclusion, and restraint. Although staffing had improved and patients told us they felt safe, this was the only ward where all staff told us they felt unsafe.
  • A number of staff left the hospital during organisational change at the beginning of the year. All wards had qualified nurse vacancies and six of the seven wards had support worker vacancies at the time of our inspection.
  • We reviewed staff rotas from April to June 2017 that showed the hospital had experienced difficulties in staffing that occurred mainly at weekends. Shortfalls were due to short notice staff absence on all occasions. Staff said that staffing had experienced “peaks and troughs” but felt it was improving.

1 November 2016

During an inspection looking at part of the service

We have changed the rating in the safe domain from requires improvement to good because:

  • The hospital acted to meet the requirement notice we issued after our inspection in February 2016.
  • Patients told us that staff treated them in a kind and respectful manner during a period of seclusion. Patients understood the reasons for their seclusion and what they needed to do for their seclusion to end. They felt supported by staff during and after their period of seclusion.
  • Staff cared for patients physical and mental health needs when patients were secluded. All patients had care plans, which addressed the patient’s safety, comfort, privacy, and dignity throughout a period of seclusion.
  • On the day of our visit, all the seclusion rooms we visited were clean and well maintained.
  • Staff documented comprehensive seclusion records that met the requirements of the hospital policy and Mental Health Act Code of Practice.
  • Staff used positive behavioural support plans and de-escalation techniques with patients and used the least restrictive practice when people were at risk of harm.
  • Senior managers took action to ensure that the hospital continued to meet the requirements of the hospital seclusion policy and Mental Health Act Code of Practice.

8 to 10 February 2016

During a routine inspection

We rated Stockton Hall Hospital as good because:

  • Services were delivered in clean and hygienic environments. Staff did regular housekeeping and cleaning audits and took action where work was required.

  • The hospital had good working relationships with commissioners and used the recovery model to focus on discharge. The multidisciplinary team assessed patients before admission, and staff and patients used a shared electronic patient record to identify goals for discharge.

  • The hospital had robust security and safety processes to keep people safe from harm. Managers kept an up-to-date risk register and staff reduced environmental risks with good relational security. Relational security is a framework used by all staff in secure hospital settings to ensure patients receive safe care and treatment.

  • Staff did ligature risk assessments and comprehensive ligature risk management plans for every ward. A ligature is a place where someone intent on self-harm might tie something to strangle themselves. Staff kept patients’ risk assessments up to date and considered how to balance between providing sufficient security and the least restrictive environment.

  • Managers had a least restrictive practice strategy for reducing incidents of restraint and seclusion across all wards. Where high incidences of seclusion had been identified, staff used positive behaviour support and de-escalation techniques. We saw use of seclusion had reduced between August 2015 and December 2015.

  • Teams included a range of staff specialities and staff were skilled and experienced working with the patient group. Staff followed good medicines management practices and patients had good access to physical healthcare. Staff received training in evidence-based psychological therapies to support patients’ needs.

  • Patients had access to a wide range of activities on the hospital site and in the community. There were good facilities available, including a gym, swimming pool and activity centre. Staff supported patients to have real work experiences and patients were involved in the development of and feedback about services.

  • Most patients and all relatives said staff were caring and respectful and had been involved in their care. Staff used the electronic care record called “PathNav” to involve patients in their care. Patients were supported with their individual interests and goals and families were supported to maintain contact where appropriate.

  • Staff told us that managers in the hospital were visible and accessible. Managers supported staff training needs and staff had opportunity to develop in their roles. Senior managers used robust governance systems and we saw good examples of audit and quality improvement activities.

However:

  • Staff did not always comply with hospital seclusion policy or the Mental Health Act Code of Practice when patients were secluded.

  • The use of restraint and seclusion was high across the hospital and some patients had to be secluded on different wards or in alternative environments such as bedrooms. We found that staff did not always protect patients’ privacy and dignity during seclusion.

  • Blanket restrictions were apparent on all wards. (These are restrictions placed on all patients rather than being based on the risks presented by individual circumstances). For example, this included set bed times and access to hot drinks and mobile phones.

  • Staff were not clear about their roles and responsibilities in relation to the Mental Capacity Act, which aims to ensure that any decisions taken on behalf of patients not capable of deciding for themselves are in their best interests. Staff were unsure how capacity decisions were documented and how to refer patients to the Independent Mental Capacity Advocate.

11 June 2013

During a routine inspection

We visited Stockton Hall as part of the annual review and also because we had received some concerns that staffing levels were not safe. When we looked at staffing overall we found that staffing levels were planned and flexible to meet needs as they occurred on each ward. However we recognised that the merging of the wards had meant that different mental health needs were now being cared for in the same area which has caused an increase of incidents on the ward.

Patients told us how they were involved in decision making both individually about their care and communally about issues that affected the hospital. They also told us that they were aware of how to raise concerns and make a complaint.

We looked at how patients were protected from the risk of abuse and found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All staff had received training and demonstrated a good understanding of safeguarding adults from abuse. We also looked at how the staff were supported and found that staff had the right training in place to safely meet patients' needs but that supervision and team meetings could be more frequently held.

We did find that the hospital needed to review practices, records keeping and the complaints process. We have therefore decided that we will continue to monitor these areas and return to the hospital to review the improvements made.

22 August 2012

During a routine inspection

We visited Stockton Hall as part of the annual review and also because we had received some concerns that some patients were not accessing their section 17 leave due to staff shortages.

We visited the two wards Farndale and Dalby and spoke to ten patients and eleven staff. Some patients who were present on the ward at the time of our visit chose not to speak to us; however, we were able to observe patients within the ward setting and saw how staff interacted with them.

Those patients who wished to talked to us told us they knew about their care plan and said they were consulted about this. They also said if any changes were needed the staff would explain the reasons for this, and they said they were given the opportunity to share their own views about any changes.

Some patients were satisfied with the care, treatment and support they received at the hospital. They said they had care plans and were able to attend review meetings with advocates to support them. They told us; 'I have a care plan and I am given a copy if I want it.' 'I see my doctor, advocate and solicitor regularly.'

Patients told us they attended weekly community meetings with staff where daily activities and leave could be organised. Patients said they had access to meaningful activities and said; 'I go to the gym and woodwork sessions.'

Some patients told us that the food generally was ok and that they had access to making a drink if they wished. Two patients told us that in their community meetings it had been agreed they would have a take away meal on one day per week, but they said they were not allowed any days in addition to this and could only choose one type of food.

Patients told us about restrictions placed on them by the smoking policy for the organisation. This meant that patients could smoke between the hours of 9am and 7pm in the smoking areas outdoors when accompanied by a member of staff. One patient told us, 'that's really hard when you can smell smoke on the staff after these times; it is also hard to wait for that morning cigarette.

One patient told us that they attended the User Involvement Group meetings and that they were given the opportunity to chair the meetings. They felt they were encouraged to have their say and represent the opinions of other patients on their ward.

Patients also told us they knew how to raise concerns or make a complaint and also confirmed that that they had access to advocacy and to their solicitors when required.

Patients explained to us that they valued their individual bedroom space and that they held a key for their room. They also told us that they could stay in bed and sleep in if they wished although staff encouraged them to engage in their programme during the week. However one patient said that they felt their privacy was compromised by their door blind being left open by staff and they were unable to close it.

8 December 2011

During a themed inspection looking at Learning Disability Services

Twelve male patients were living on Kyme ward. We met and introduced ourselves to 11 patients and spoke with six patients in more depth to get their views of the service.

When we first arrived one patient told said, 'Staff are brilliant on this ward.' Overall, patients told us they were satisfied with the care and treatment at Kyme Ward. However, some patients said they didn't feel safe because a new patient had been admitted who had attacked another patient and some of the staff. More than half of the patients we spoke with were not happy about some of the rules. They told us that they took part in activities, but were sometimes bored, especially at weekends.

Patients told us the staff supported them to be involved in putting their care plans together and going to review meetings, and that they had access to independent advocates. That was someone from outside of Kyme Ward who came in and spoke up for them.

16 December 2011

During an inspection in response to concerns

We carried out a responsive review of Stockton Hall at 6:45 am on Saturday 17th December 2011; this was because we had received information that there was insufficient suitably qualified, skilled and experienced staff working at the weekends and at nights.

During out visit we went to Kyme, Fenton, Kirby, Farndale and Dalby units, we talked to ten patients and seventeen staff.

We asked the ten patients about whether they believed there was sufficient staff to meet their needs at the weekend and at nights, seven told us they believed there was 'not enough' staff and they told us the ways this affected them. For example they were sometimes unable to have escorted leave in the grounds and in the community at weekends. They felt 'ignored' and had been unable to take part in supervised activities at the weekend such as 'pool or X box'.

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.