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Huntercombe Hospital - Maidenhead Good

Inspection Summary


Overall summary & rating

Good

Updated 12 August 2019

We rated Huntercombe Hospital Maidenhead as Good because:

  • The wards had enough nurses and doctors. Staff assessed and managed risk well, followed good practice with respect to safeguarding, and had a dedicated social work team with a named social worker for each ward.
  • The provider had made substantial progress in the reduction of restrictive practices and blanket restrictions across the hospital.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the young people and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of young people on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • Staff treated young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of young people. They actively involved young people and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that could provide aftercare, and while delayed discharges did occur due to the lack of available specialist placements, the provider worked closely with commissioners and other providers to seek suitable alternatives.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly. The provider was engaged in a number of initiatives to improve staff wellbeing and morale, and invested well in training and career development.
  • Young people and their carers gave mostly positive feedback about the relationships they had with staff and the impact of their treatment on their lives.

However:

  • Physical health was inconsistently monitored using the paediatric early warning system (PEWS) which meant there was a risk that a young person’s deteriorating health might not be identified early enough.

  • The service was not applying a positive behaviour approach to the management of behaviour that challenged, as staff who had been previously trained had left the organisation. Staff training levels in positive behaviour support were below target at 57%.

  • At the time of our inspection, only 67% of staff had received mandatory training in the Mental Health Act. This had increased to 73% for all staff within two weeks of the visit, which was still below the target of 75%.
Inspection areas

Safe

Good

Updated 12 August 2019

We rated safe as good because:

  • All wards were clean, well equipped, well furnished and well maintained. Challenges posed by the layouts, age and listed status of the wards were generally well managed through staff observations and adaptations, for example, perspex across windows and secure netting across the stairwell in the main building.

  • The service had enough nursing and medical staff, who knew the young people and received basic and specialist training to keep young people safe from avoidable harm.

  • Staff assessed and managed risks to young people and themselves well and followed good practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme, which had made significant progress since the last inspection.

  • Staff understood how to protect young people from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The provider had a named safeguarding leads at ward level, in the social work department, and within the senior leadership team.

  • Staff had easy access to clinical information via the electronic case management system and it was easy for them to maintain high quality clinical records.

  • The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s physical health.

  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave young people honest information and suitable support.

However;

  • The age and listed status of some areas of the building posed challenges to patient safety that could only be mitigated through increased staffing.

  • We observed examples of staff applying the medicines management policy inconsistently with regard to the recording of controlled drugs and the disposal of medicines.

  • Not all mandatory training was at or above the required level of 75%. PREVENT (prevention of radicalisation) was at 66% and search at 54%.

Effective

Requires improvement

Updated 12 August 2019

We rated effective as requires improvement because:

  • While all young people received a comprehensive physical health and medical assessment on admission, staff were inconsistent in their use of the Paediatric Early Waring Scale (PEWS).
  • Positive behaviour support (PBS) had not been effectively embedded at the service, as staff members who had received advanced training the previous year had left the organisation. Only 57% of staff had completed the training. This was clearly detailed as a priority on improvement plans for the service.
  • On one of the three wards, only 67% of staff had received supervision within the 42 day period specified in the provider’s supervision policy.

  • Data submitted by the hospital prior to the inspection shows that only 64% of staff had received training in the Mental Health Act. This had increased to 73% within two weeks of the inspection visit, but was still below the required level of 75%.

However, we found the following examples of good practice

  • Staff assessed the physical and mental health of all young people on admission, and consistently completed admission checklists. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured that young people had good access to physical healthcare.
  • Staff participated in clinical audit, benchmarking and quality improvement initiatives.
  • The ward team included or had access to the full range of specialists required to meet the needs of young people on the ward. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit young people. They supported each other to make sure young people had no gaps in their care. The ward team had effective working relationships with other relevant teams within the hospital and with relevant services outside the organisation.
  • Staff supported young people to make decisions on their care for themselves proportionate to their competence. They understood how the Mental Capacity Act 2005 applied to young people aged 16 and 17 and the principles of Gillick competence as they applied to young people under 16. Staff assessed and recorded consent and capacity or competence clearly for young people who might have impaired mental capacity or competence.

Caring

Good

Updated 12 August 2019

We rated caring as good because:

  • Staff treated young people with compassion and kindness. They respected young people’s privacy and dignity. They understood the individual needs of young people and supported young people to understand and manage their care, treatment or condition.
  • Staff involved young people in care planning and risk assessment and actively sought their feedback on the quality of care provided. The hospital actively considered requests from young people around the reduction of restrictive practices, and had recently enabled young people to safely have access to smart phones, internet and television streaming services on the wards. Monthly service user involvement meetings were an opportunity for young people to give feedback and make suggestions and requests.
  • The hospital ensured that young people had easy access to independent advocates, who attended monthly clinical governance meetings to feed back themes to the senior leadership team.
  • The service had endeavoured to make the hospital more young-person friendly, for example, through the appointment of youth engagement practitioners to organise fun activities, the introduction of canine-assisted therapy and through consulting young people on how the wards and main areas could be decorated.
  • Parents and young people told us that communication between ward staff and families could be poor. The provider had begun improving communication with families through family information days and personalised communication plans for each patient. These plans included a named point of contact for every young person, and details of how to reach them.

However:

  • Some young people told us that ad hoc agency staff were less caring and approachable, and less considerate of their needs, for example, being noisy at night time and talking to each other in languages other than English, which young people found unsettling. The hospital management had acknowledged these concerns and were carrying out spot checks at night and issuing best practice bulletins to staff.

Responsive

Good

Updated 12 August 2019

We rated responsive as good because:

  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. Where discharge was delayed due to the lack of suitable alternative provision, the hospital worked closely with commissioners to try to address this.
  • Staff facilitated young people’s access to high quality education throughout their time on the wards.
  • Young people could make hot drinks and snacks at any time
  • The wards met the needs of all young people who used the service, including those with a protected characteristic. Staff helped young people with communication, advocacy and cultural and spiritual support.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

However:

  • The design and layout of the wards did not always support young peoples’ privacy and dignity. On Severn ward, newly fitted doors had viewing panels that could not be controlled from inside the room by the patient, only by staff from the outside. Hospital managers told us that this had been an oversight and committed to have the panels adjusted straight away.

Well-led

Good

Updated 12 August 2019

We rated well-led as good because:

  • 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 young people and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

  • The service invested well in the learning and development of staff, providing enhanced training opportunities and opportunities for career progression.

  • Senior leaders had engaged the service in new initiatives to improve the wellbeing and morale of staff, with a view to improving recruitment and retention.

  • Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.

  • Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff engaged actively in local and national quality improvement activities

However:

  • Whilst all senior clinical leadership roles were covered, some were temporary staff while permanent appointments were made. All wards always had medical cover from a consultant, junior doctor, and/or associate specialist, however there was a potential risk that the number of temporary arrangements could create sudden change, for example, a locum doctor leaving at short notice.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 12 August 2019