You are here

York House Independent Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 29 December 2017

We rated York House Independent Hospital as good overall because:

Following the last comprehensive inspection on 7 and 8 February 2017, we rated the hospital as good overall. We rated the service good for the effective, caring, responsive and well led domains and requires improvement for the safe domain. We issued a warning notice and a requirement notice under Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act (Regulated Activities) Regulations 2014. We told the hospital that staff must adhere to the hospital policy in relation to physical health monitoring following the administration of medication for rapid tranquillisation and ensure that all mandatory training meets the hospital compliance target. During this focused, follow up inspection, we found that the service had addressed the issues that had caused us to rate safe as requires improvement following the February 2017 inspection.

We rated the service requires improvement for safe because:

  • There was no overall ward level ligature audit that identified all ligatures on the ward. This was not in accordance with National Patient Safety Agency guidance.
  • Clinic rooms were too small to have examination couches and were cluttered. Medicines fridge temperatures were not always recorded daily in accordance with national guidance.
  • There was limited multidisciplinary team support at weekends.
  • Staff recorded incidents of harm as a result of patient assault, and prevention management of violence and aggression training was classified as desirable for nursing staff.
  • York House hospital had not updated its local observation protocol to reflect the Disabilities Trust policy for corridor observations. This was identified at the last inspection. Staff were completing the observations but this did not reflect the local protocol.

However;

  • Medicines management practice had improved. The provider had taken action to ensure that staff adhered to hospital policies in medicines management and staff acted in accordance with national guidance after they administered rapid tranquillisation to patients. The provider had introduced a prompt that explained rapid tranquilisation expectations and gave staff guidance on physical health checks and escalation. Risks associated with the administration of medicines for rapid tranquillisation were audited and reviewed.
  • Mandatory training compliance for contracted staff had improved. First aid training was 5% below target however training was scheduled for November 2017. Wards identified staff with this training each shift and moved them to cover wards to ensure there was a suitable skill mix. Bank staff training was lower than the mandatory training compliance rates for eight courses but the service had implemented an online training platform to address this issue. Staff that did not have suitable training were not offered shifts on the wards.
  • Staff now complied with infection prevention and control measures. The hospital’s infection control lead completed infection prevention and control checks of staff and the environment.
  • The reporting system that staff completed when incidents occurred now indicated the level of harm sustained because of the incident. The provider was also in the process of implementing a new electronic recording system that was to be fully rolled out by December 2017.
Inspection areas

Safe

Requires improvement

Updated 29 December 2017

We rated safe as requires improvement because:

  • There was no overall ward level ligature audit that identified all ligatures on the ward.
  • Clinic rooms were cluttered and were too small to have examination couches. Medicines fridge temperatures were not always recorded daily in accordance with national guidance.
  • There was limited multidisciplinary team support at weekends.
  • Staff recorded incidents of harm as a result of patient assault, and prevention management of violence and aggression training was classified as desirable for nursing staff.

  • The Disabilities Trust policy acknowledged that there should be a member of staff present at all times at corridor locations but we did not see this reflected in the local protocol. This was identified at the last inspection.

However;

  • The wards were clean, met same sex accommodation guidance and were well maintained. Staff monitored the appearance of the wards and each ward had an infection control champion. The infection control lead completed regular infection control audits.
  • Medicines stored in clinic rooms and medicine refrigerators were stored securely with access restricted to authorised staff. There were adequate supplies of oxygen, defibrillators and medicines for use in a medical emergency available for each ward. Staff carried out regular checks to ensure these were available and fit for use.
  • Nursing staff on the wards followed a shift pattern that allowed for the movement of staff between wards to cover increased levels of patient activity at peak periods during the day. Staffing shortages were covered by bank and agency staff that specialised in brain injuries and were familiar with patients and unit. Escorted leave and activities were rarely cancelled because of staffing shortages.
  • Patients had comprehensive risk assessments that were regularly reviewed by the multidisciplinary team.
  • The provider had introduced a prompt that explained rapid tranquilisation expectations and gave staff guidance on physical health checks and escalation. Risks associated with the administration of medicines for rapid tranquillisation and audited and reviewed.
  • Staff knew how to raise safeguarding concerns raised concerns via the provider’s safeguarding form and the incident management system recorded level of harm. Staff and patients were debriefed following incidents and families and carers were kept updated.

Effective

Good

Updated 29 December 2017

Since the last comprehensive inspection in February 2017, we received no information that would cause us to re-inspect this key question.

Caring

Good

Updated 29 December 2017

Since the last comprehensive inspection in February 2017, we received no information that would cause us to re-inspect this key question.

Responsive

Good

Updated 29 December 2017

Since the last comprehensive inspection in February 2017, we received no information that would cause us to re-inspect this key question.

Well-led

Good

Updated 29 December 2017

Since the last comprehensive inspection in February 2017, we received no information that would cause us to re-inspect this key question.

Checks on specific services

Services for people with acquired brain injury

Good

Updated 29 December 2017