Eleanor

Updated 6 October 2023

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.

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

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

The provider was registered to provide the following regulated activities:

• Diagnostic and screening procedures
• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder, or injury

We visited Athena ward on the ground floor of the hospital. There were two further wards at the hospital, Eos and Harmonia wards, which were not in use at the time of this inspection.

The service was inspected on 12 May 2022 and was rated as inadequate in safe, caring and well led. A further inspection on 22 July 2022 led to the serving of a section 29 warning notice in relation to Regulation 12 of the Health and Social Care Act Regulations 2014.There were serious issues regarding staffing, risk assessment and risk management and restraint training.

The service had undergone significant change since these inspections, and had not had patients resident in the service until May 2023.

A registered manager was in post and a controlled drugs accountable officer registered with CQC.

We raised some specific issues immediately following this inspection and received assurances from the provider about actions they had taken.

What people who use the service say

We spoke to both patients in the service at inspection. We received mixed feedback. There was positive feedback for staff and support on the ward, including use of “the stop” (an area of the ward where patients could sit to highlight they were needing support rather than having to find/ask staff) for additional support. Patients knew who their named nurse was and had regular individual sessions with them. Patients had been able to personalise their room before admission, including the colour of the walls. The frequency of multidisciplinary team meetings was raised; these were fortnightly at the time of inspection and not felt to be frequent enough. The lack of ward based activities and occupational therapy input was also raised. Patients were aware of blanket restrictions (ward based rules in place) and understood the rationale for some of these, but restricted access to the garden and rules around the frequency of vaping were raised as issues.

Updated 6 October 2023

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.

Updated 6 October 2023