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

Eleanor

Overall: Inadequate read more about inspection ratings

Harnham House, 134 Palatine Road,West Didsbury, Manchester, Lancashire, M20 3ZA (0161) 448 1851

Provided and run by:
Eleanor EHC Limited

All Inspections

20 June 2023

During an inspection looking at part of the service

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

  • We had concerns about the oversight and governance in this service and we have issued a warning notice to the provider. There were issues with the assurances from clinical audits. We reviewed eight personnel records. We found all had missing or incomplete information. Staff had not completed all mandatory training and we were not assured that training was consistently taught and covered all standard requirements. The oversight of training meant it was difficult to be sure that staff were suitably trained. The training system and spreadsheet did not match with induction data.
  • There was little evidence in patient records of senior medical reviews taking place. The speciality doctor was leaving and there was no replacement cover. We were not assured that a doctor could attend at night in an emergency.
  • Observation levels were not always reviewed following incidents and observation forms were not always fully completed with frequency and reasons for observations.
  • There was no legal authority in place for one patient who had received rapid tranquillisation on a number of occasions.
  • Capacity assessments relating to consent to treatment were not fully completed and did not evidence a meaningful discussion had taken place.

However:

  • Athena ward had been refurbished and redecorated to a high standard.
  • Staffing in the service had improved and the service had enough nursing and support staff to keep patients safe.
  • All patients had positive behaviour support plans which were developed by the psychology and wider multidisciplinary team members.

22July 2022

During an inspection looking at part of the service

This was an urgent focused inspection, due to concerns we had around the safety of patients within the service and the care they were receiving. The focus of the inspection was on the assessment and management of patient risk.

This inspection was not rated.

We found that:

  • The service was not safe. It did not have enough staff to provide care for the patients. Staff did not manage risk well. Permanent and agency staff did not have the same level of training to ensure they could work together to restrain a patient.
  • Risk assessments had been completed but were not reflective of patient risk or up to date. For example, we found these to either not reflect incidents that had occurred before the assessment or had not been updated following incidents. There was no evidence that the multi-disciplinary team had met to review and discuss newly presenting patient’s risk.
  • Staff did not know about risks to each patient and how to act to prevent or reduce risks. Staff did not have access to consistent risk documentation for example, briefing documents contained conflicting advice on the risk’s patient presented with.

12 May 2022

During an inspection looking at part of the service

Eleanor Independent Hospital provides care and treatment for up to 34 patients.

At the time of the inspection there were 14 patients at the hospital.

The wards we visited were:

Oriel ward – a rehabilitation ward for women primarily diagnosed with personality disorder which has nine beds.

Cavendish ward - Cavendish ward is a rehabilitation ward for women with a primary diagnosis of mental illness, it has 10 beds.

This inspection was carried out urgently as a focused inspection, due to concerns we had around the safety of patients within the service and the care they were receiving.

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

The service had previously been inspected in April 2021 and was rated required improvement.

The service did not have a registered manager at the time of our inspection and the controlled drugs accountable officer was detailed as someone who had left the service some time ago.

The service was not safe. It did not have enough staff to provide care for the patients. Staff did not manage risk well.

We had significant concerns about the medicine’s management at the hospital. We found many errors including prescribing, recording, and dispensing of medicines.

Staff did not develop meaningful care plans and risk assessments which meant staff were often working from out of date or incorrect information. The risk assessment process was flawed in that various formats were used at one time, this meant staff were not working with the most up to date and effective methods to manage and reduce risk.

The hospital was not caring. Patients and carers told us that patients were not at the forefront of their own care. Patients told us that staff were on their mobile phones, talking in different languages to the ones they used and did not know the reasons they were in hospital and how to help them.

The service was not well-led, there was no registered manager at the time of our inspection. The provider lacked oversight of the service provided at the hospital. The governance processes did not ensure that ward procedures ran smoothly.

We will add full information about our regulatory response to the concerns we have described to a final version of this report, which we will publish in due course

21 April 2021, 22 April 2021, 5 May 2021

During an inspection looking at part of the service

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

  • The environments were restrictive, with kitchen and garden areas locked.
  • Oriel ward had become more restrictive since opening, with the original open kitchen area being walled in and locked and plastic crockery introduced.
  • The service is registered as a rehabilitation service but currently does not have a rehabilitation model. The service had a statement of purpose which referred to Oriel ward as a rehabilitation setting. The provider is working on draft proposals for the service being rebranded as a specialist personality disorder setting.
  • Some patients on Oriel ward spoke about the difficulties of the ward having two distinct patient groups currently since the female rehabilitation ward was being refurbished.
  • The service was still in the process of recruiting members of the multidisciplinary team. The service model, particularly in relation to Oriel ward, was newly developed and not yet established.
  • The service had high rates of bank and agency nurses and high rates of bank and agency nursing assistants.
  • Most of the patients we spoke to on Oriel ward expressed some concerns about the number of temporary staff on Oriel ward.
  • Some patients said they found their care and treatment inconsistent at times and there was sometimes poor communication across the staffing team.
  • Staff were not receiving thorough regular, constructive appraisals of their work
  • The occupational therapy kitchen area formed part of a large activity room and was located off the wards in the main hospital building. We found the fridge was not temperature checked. There were out of date foods in the fridge including butter and spreads. There were also several items which were part used but not labelled as to when they were opened.
  • At the last inspection in 2018 we noted that not all staff had their own email address and each ward had a mailbox which all staff accessed. This had not changed.
  • Some policies were in need of review and updating in relation to risk management and observations.
  • Patients told us they had raised complaints but these were not on the service complaints log.

However:

  • All wards were safe, clean well equipped, well furnished, well maintained and fit for purpose.
  • Staff followed infection control policy, including handwashing. Staff had completed and kept up-to-date with their mandatory training.
  • Staff completed risk assessments for each patient on admission / arrival, using a recognised tool, and reviewed this regularly, including after any incident.
  • Staff completed a comprehensive mental health assessment of each patient either on admission or soon after.
  • All patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward.
  • Care plans were personalised, holistic and recovery-orientated.
  • Staff made sure they shared clear information about patients and any changes in their care, including during handover meetings.
  • Most patients spoke positively about nursing and occupational therapy staff.
  • Patients told us staff were discreet, respectful, and responsive when caring for patients. We also saw incidents that occurred during this inspection which were dealt with in a calm, reassuring way by staff.
  • Patients could give feedback on the service and their treatment and staff supported them to do this.
  • The hospital had been subject to an extensive refurbishment programme over the last 12 months. This had involved all wards being redecorated and new flooring fitted, new bathrooms and bedroom furniture, replacement of windows, air conditioning installed and a repurposing of Montrose ward. The hospital also had installed a wireless internet service for patients to use.
  • Staff made sure patients had access to opportunities for education and work, and supported patients.
  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.
  • Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.

To Be Confirmed

During a routine inspection

We rated Jigsaw independent hospital as good because:

  • The service was clean and newly refurbished. Ligature risks were well managed.Staff had completed comprehensive risk assessments for patients and these were up to date and reviewed regularly. Practice in relation to moving and handling and falls assessment and management had improved. Moving and handling risk assessments were in place for all patients who needed these and included falls risk information and plans.
  • Care records contained up to date, personalised, holistic care plans. Staff had created easy read or pictorial care plans for some patients who needed these. There was excellent psychology and occupational therapy provision. Physical healthcare needs were assessed and monitored, with care plans devised to capture this. A practice nurse had been appointed part time to assist staff with physical healthcare monitoring.
  • We saw positive interactions between staff and patients during this inspection. Patients were positive about staff, describing them as kind, respectful, polite and caring. Two carers gave positive feedback about their relative’s care.
  • All admissions to the hospital were planned. A pre-admission assessment was completed by clinicians before placement was offered and this included a detailed breakdown of proposed interventions and treatment and a timescale for admission. The hospital managers and commissioning lead had been proactive in identifying the next steps for some patients and in liaising closely with commissioners to plan successful patient discharges.

However:

  • The service had made progress in identifying and reviewing blanket restrictions but there were still some blanket restrictions in place. These were in relation to rooms and outside space; which patients were not able to access.
  • Not all staff had their own confidential email address and each ward had a mailbox which all staff accessed.
  • The service has not ensured ongoing arrangements for recruitment and training of hospital managers in relation to the Mental Health Act 1983.
  • Most patients were involved in activities but patients mentioned a lack of activities at evenings and weekends. This had been highlighted in a recent patient survey.
  • Some patients told us they did not use the complaints system as they felt it was not effective.

23 & 24 January 2018

During an inspection looking at part of the service

At the last inspection the service was rated as requires improvement, with ratings of good for effective, caring and responsive domains.

This inspection focused on the safe and well led domains, which were both rated as requires improvement previously.

Improvements had been made following the previous inspection. At the last inspection, there were issues with governance in terms of training levels, policies, ligature audits and out of date clinical stocks. At this inspection, we found most of these issues had been addressed with training monitored, policies updated, a new system for completing ligature audits in place and no medicines issues. Ligature risk assessments were improved although for one ward they did not capture all potential risks. Whilst there were records for regular supervision with staff and improved oversight, we were concerned about the use of a pre-filled template which staff signed.

At this inspection, we had concerns with oversight in terms of staffing, particularly that there had been occasions in the past six months were one registered nurse had been in charge of two wards and monitoring, in terms of assessing the quality of documentation, for example, moving and handling assessments.

We found issues with moving and handling assessments, falls risk assessments and care planning in relation to moving and handling and falls prevention.

10 & 11 January 2017

During an inspection looking at part of the service

We rated Jigsaw Independent Hospital as requires improvement because:

We inspected Jigsaw Independent Hospital to see whether improvements had been made following a comprehensive inspection in March 2016. At that inspection, we had issued requirement notices for breaches of regulations relating to person centred care, good governance, staffing and duty of candour.

A warning notice had been served for a breach of regulation 12 of the Health and Social Care Act (2014) and an inspection visit in August 2016 confirmed that issues had been addressed and this warning notice was met.

At this current inspection, we found improvements and changes had been made throughout the hospital.

There had been a review of blanket restrictions throughout the hospital and many of the restrictions that had been in place had been altered. There was a collaborative multidisciplinary approach to delivering care. There had been a review of patient pathways throughout the service and evidence of discharge planning was apparent from talking to patients and reviewing records. The hospital now had a clear admission process.

In terms of good governance, we found records were well maintained and comprehensive. Physical health information was included in health passports. A new governance structure had been established and this ensured information was communicated up to board level and back down to ward level. A duty of candour policy had been developed and staff were aware of this. We found that although overall governance had improved, there were still areas which lacked sufficient oversight, for example, training levels, policies, ligature audits and out of date clinical stocks. There were also still issues with the Mental Health Act policies despite these being reviewed.

23 August 2016

During an inspection looking at part of the service

This was a focused inspection relating to issues identified at a previous inspection following which we served a warning notice. We have not rated services at this inspection.

We issued a warning notice following a comprehensive inspection in March 2016 relating to regulation 12: safe care and treatment.

We found:

  • staff did not know about environmental risk assessments and what they needed to do to reduce risks.
  • there was no effective system in place to ensure that patients were only given medicine that was authorised
  • patients were not always getting their medicines as prescribed
  • patients who were prescribed high doses of antipsychotic medication, above the limits recommended in the British National Formulary (BNF), were not receiving increased monitoring to check for any adverse effects. There were no guidelines for high dose antipsychotic treatment and monitoring in the medication policy
  • medication was not stored appropriately, which meant that patients were at risk of being given medications which were not effective, and medicines were not being disposed of safely.

At this inspection, we assessed whether the service provider had put right issues identified in the warning notice. We found improvements in terms of safe care and treatment and that the provider had met the requirements of the warning notice.

We found:

  • staff knew about risks on their ward, how to reduce risks and all three wards had ligature risk assessments in place
  • forms for authorising treatment, certifications showing that a patient had consented to their treatment (T2) or that it had been properly authorised (T3) were completed and attached to medicine charts where required
  • staff checked medication stock levels to ensure the correct medicine was available for patients and records showed staff gave medicines to patients as prescribed. Staff ensured that patients who went on leave had their medicine with them. This was in the form of blister packs
  • the provider had reviewed the medicines policy, and it now included guidance on high dose antipsychotic monitoring and rapid tranquillisation monitoring. Staff completed a high dose antipsychotic monitoring form and patients’ care files had a sticker to indicate increased monitoring required
  • all medicines were in date and appropriately stored.

21, 22 and 23 March 2016

During a routine inspection

We rated Jigsaw Independent Hospital as requires improvement because:

  • The hospital was not managing medicines safely. Patients were not always getting the medicines that were prescribed. The correct forms of authorisation or consent for detained patients did not always include all the medicines that were prescribed. There were no monitoring guidelines or policies for high dose antipsychotic treatment or for rapid tranquilisation.
  • Staff were not aware of the environmental risks on the wards and the actions needed to lessen them.
  • There were blanket restrictions in place, which meant that patients could not make hot drinks and snacks for themselves regardless of whether they had been assessed as safe to do so.
  • Training rates for five of the 16 mandatory training courses, including basic and immediate life support, were below the 75% target.
  • The information contained in the patients’ risk assessments was basic and did not always contain interventions.
  • Policies relating to the Mental Health Act had not been updated to reflect the current code of practice.
  • The appraisal rate for staff was low (39%) and only 60% of support workers and 71% of qualified staff had received supervision.
  • Patients had limited access to psychological support to aid their recovery. Patients did not know what they had to do to be discharged and care plans were not recovery focused.
  • Patients who were detained under the Mental Health Act were being prescribed medicines that were not included in the appropriate forms of consent.There were no admission criteria for the hospital so it was difficult to measure if the admission was appropriate
  • The governance system was not effective at identifying where care was falling below standards.

However,

  • Risk assessments were completed on admission and reviewed regularly.
  • Staffing levels and skill mix were planned, and shortages were actioned promptly.
  • Patients had access to an independent mental health advocate.
  • Staff were caring and treated the patients with kindness and dignity.
  • Staff told us they were supported by the management team.
  • Complaints were managed well.
  • Patients detained under the Mental Health Act had their rights explained to them.
  • The service had good links with local commissioners.

30 September and 1, 10 October 2013

During a routine inspection

We were accompanied by a Mental Health Act Commissioner (MHAC). The Mental Health Act Commissioner considers whether the hospital was working within the Mental Health Act and the Mental Health Act Code of Practice.

We spoke with seven people who were being cared for in this hospital about their care and treatment. The Mental Health Act Commissioner also spoke with people detained on the Mental Health Act on two units. Patients generally told us they felt well cared for and were happy. One patient stated: "I enjoy it here. We do all sorts". Detained patients told us that they had been given information about their rights. We heard mixed comments on the availability of the activities on the units. One person said: "Staff are alright - they talk to us at night, play table tennis; even the manager". Another person said: "There's not much to do in the way of activities". Some patients we spoke with commented on the bullying that occurs from other patients. Patients did state that they felt that staff did what they could to keep people safe and prevent incidents of bullying.

The provider was meeting all the essential standards we looked at on this inspection. We have made some suggestions in the report which the managers of the hospital may wish to consider.

27 November 2012

During a routine inspection

We spoke with nine people who were being cared for in this hospital about their care and treatment. We also spoke with one relative of a person being cared for in this hospital. People we spoke with were generally felt positive about the care they received and felt safe most of the time. We were made aware that there had been instances of bullying by other patients on occassions. We discussed this with people who used services. We found that the service dealt with bullying and took active steps to deal with this issue.

We went with a Mental Health Act Commissioner. The Mental Health Act Commissioner considers whether the Mental Health Act and the Mental Health Act Code of Practice is being followed. They also proactively visit and interview people who are detained under the Mental Health Act. The Mental Health Act Commissioner interviewed a further six detained patients.

We found that the provider was meeting the standards we looked at during this inspection.

16 December 2011

During an inspection in response to concerns

The people who use services we spoke with were positive about the care and support they received at the hospital. They told us they were getting the leave they were entitled to. People said that leave was only cancelled if they were not well enough to go out. They said that sometimes they had to wait to go out but staff always discussed any changes in arrangements with them. People who use services told us that staff looked after them well. They felt able to talk to staff and were confident that staff would help them. One person told us that they preferred being at Jigsaw than the previous hospital they had been at.

31 January and 10 February 2011

During an inspection looking at part of the service

People told us that they were happy with the care they received at the hospital. They were complimentary about the staff. They felt that staff listened to them. They knew their rights and felt able to express concerns to staff.

Two people told us that they did not get all the Section 17 leave that they were entitled to. They said that they would prefer less frequent, longer periods of leave.

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.