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Inspection report

Date of Inspection: 18, 21 November 2014
Date of Publication: 10 February 2015
Inspection Report published 10 February 2015 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 18 November 2014 and 21 November 2014, observed how people were being cared for and talked with people who use the service. We talked with staff, reviewed information given to us by the provider, were accompanied by a pharmacist and were accompanied by a specialist advisor.

We were accompanied by a Mental Health Act commissioner who met with patients who are detained or receiving supervised community treatment under the Mental Health Act 1983.

Our judgement

People did not always experience care, treatment and support that met their needs and protected their rights.

Reasons for our judgement

We reviewed 11 patients' care records across the service. Prior to admission, patients had been assessed by a consultant and a nurse and information from their previous placement was reviewed. A 72 hour care plan and risk assessment had been implemented on admission.

The sample of care records we looked at included care plans, risk assessments and care programme approach (CPA) documents. Most of these were fully completed and showed involvement and acknowledgement of the person's needs and what action was needed to support them. For example, on Greenacre ward we saw detailed recording of support plans, evaluation and review at multi-disciplinary team (MDT) meetings for a patient in long term, self-imposed segregation. However, on Park View Ground ward we found that a patient's risk assessment had rated them at high risk of self-neglect and vulnerability. We could not find a care plan with detailed interventions for staff to support the patient and had no further information as to what the risks were.

Some patients on Park View Ground ward were on enhanced observations, where they had a member of staff with them at all times. The care records did not have care plans or risk assessments to demonstrate why enhanced observations were required, what concerning behaviour staff should be aware of, and how care should be provided. We asked staff and managers to tell us the reasons that specific patients were on enhanced observations, but the information we were given was contradictory.

We saw that individual support plans had been developed for patients to ensure that staff had information about their individual needs and wishes. This information included personal preferences and goals to make sure patients' wishes and needs were respected. We saw evidence of recent MDT and CPA meetings that had been held to review the support that was provided. This had involved patients, their representatives and various health and social care professionals.

Patients had their capacity to consent to decisions routinely assessed and recorded. The sample of records we looked at showed that people’s capacity had been assessed and recorded, both on admission and in weekly MDT meetings.

We reviewed a sample of seclusion and segregation records and found they had been completed correctly. We saw that information about the use of seclusion was recorded and monitored across the service.

The service had policies about the management of challenging behaviour. However, detailed information about challenging behaviour, the action taken and its effectiveness was not consistently recorded. The service had a policy entitled "De-escalation and management of challenging behaviour", which stated: “A record of the post incident debriefing for staff and young people will be recorded on the incident form and included in the ward electronic report”. Staff told us that after an incident a debriefing meeting sometimes took place. This included all the staff involved in the incident and gave them time to ask questions and reflect on their practice. However, we could not find evidence of these having been recorded. The same policy stated that, “The de-escalation form is to be used when a young person responds to de-escalation interventions/techniques and returns to mix with peers. These interventions also need to be recorded on an incident form (if used) and in the MDT notes”. Although incident forms stated "de-escalation techniques used" it was not clear what these techniques were and we could not find evidence of a de-escalation form being used. The care records did not include the recording of patient debriefing.

Staff and management were kept up to date about any changes to patients' needs. Handover meetings were held each morning between the nurse in charge of the night shift and all staff arriving for the day shift. Senior nurses attended a daily management meeting and information was further discussed with consultants and managers. Changes to patients ca