The Care Quality Commission
  • Hospital
  • Independent hospital

Archived: The Glenside Hospital for Neuro Rehabilitation

Overall: Good read more about inspection ratings

Glenside Manor Healthcare Services Limited, South Newton, Salisbury, Wiltshire, SP2 0QD (01722) 742066

Provided and run by:
Glenside Manor Healthcare Services Limited

All Inspections

8 November 2018

During an inspection looking at part of the service

The Glenside Hospital for Neuro Rehabilitation is operated (since August 2017) by Glenside Manor Healthcare Services Limited. The Glenside Hospital for Neuro Rehabilitation is an independent healthcare organisation which provides different levels of care to patients with an acquired brain injury.

The hospital service is split into two sections, the neuro-rehabilitation unit (NRU), and the neuro-behavioural unit (NBU). NRU includes three wards; Avon, Bourne and Wylye (27 beds total), each one led by a senior clinical nurse and a consultant in rehabilitation medicine and rheumatology. These wards could accommodate patients with complex nursing needs, providing physical and cognitive rehabilitation, tracheostomy management and weaning, and nutritional management. The wards have single rooms with ensuite bathroom facilities, which are used for male or female patients.

The NBU is run as a single 14‐bed service, including two wards Ebble and Nadder, and led by a senior clinical nurse and a consultant in neuropsychiatry. The NBU focuses on neuro behavioural interventions which aim to control, reduce and eliminate challenging behaviour, and admits patients detained under the Mental Health Act 1983.

Based in Salisbury, the hospital serves the South West, and takes referals from across the country. On the same hospital complex there are also seven adult social care services. Each service is registered separately with CQC, which means each site on the main complex has its own inspection report.

While each of the services are registered separately, some of the systems are managed centrally, for example, maintenance, systems to manage and review incidents and systems for managing medicines. Physiotherapy and occupational therapy staff cover the whole complex and all services. Factilities such as the hydrotherapy pool are also shared across the whole complex.

We carried out an unannounced focused inspection on 8 November 2018. The inspection was prompted by whistleblowing concerns and information of concern shared with us through intelligence monitoring and system partners. We looked at some elements of safe, effective and well led, and did not rate the service at this inspection.

At the time of our inspection, the CQC adult social care inspection team were undertaking a comprehensive inspection of social care sites, which provide a range of services to complement the neurorehabilitation and the neuro-behavioural pathways. These will be reported on separately although all reports will share some themes around those systems that are centrally managed.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We found areas of practice that require improvement in services for people with long-term conditions:

  • The service provided mandatory training in key skills to staff but did not make sure everyone completed and understood it. We were not assured there were adequate systems and processes in place to monitor or evaluate mandatory training, or to follow up areas of low compliance.

  • There were not robust systems and processes in place for safeguarding or that all staff understood how to protect patients from abuse.

  • Infection risks were managed inconsistently and were not being monitored.

  • The environment and maintenance of equipment was not managed safely and placed people at risk.

  • Staff did not always complete and update all relevant risk assessments for each patient, or take action to ensure patients were appropriately placed or their physical and rehabilitation needs were fully met. They did not always keep clear records or ask for support when necessary.

  • The service did not have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • Staff did not always keep accurate records of patients’ care and treatment. Records were not all up to date or truly reflective of the patients’ needs.

  • The management of medicines at the hospital was not safe and there were problems with the supply of medicines into the service. There was no clinical pharmacy oversight or service to support medicines management which increased the risk of errors.

  • The service did not manage patient safety incidents well. Staff recognised incidents but did not always report them appropriately. Not all incidents were reported or investigated and lessons learned were not shared with the whole team or the wider service.

  • The service did not monitor safety effectively or use results well. Staff did not routinely collect safety information across all wards, or share it with staff, patients and visitors. We found no evidence to show managers used this to improve the service.

  • The service did not have systems and processes to make sure staff were competent for their roles. Some training in specific skills for roles was provided but managers did not ensure these were attended by all staff.

  • Not all staff understood their roles and responsibilities under the Mental Capacity Act 2005 or deprivation of liberty safeguards (DoLS). Patients described as lacking capacity to consent to admission and treatment did not have an assessment of their capacity recorded. Legal processes for detained patients were not adhered to.

  • Leaders of the service did not have the right skills and abilities to run a service providing high-quality sustainable care.

  • The service did not have a vision for what it wanted to achieve or workable plans to turn it into action. Staff, patients, and local community groups had not been involved in developing a shared vision for the service.

  • Managers across the service did not all promote a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service did not systematically improve service quality or safeguard high standards of care by creating an environment for excellent clinical care to flourish.

  • The service did not have good systems to identify risks, plan to eliminate or reduce them, or cope with both the expected and unexpected.

  • The service did not demonstrate a commitment to improving services by learning from when things went well or wrong, promoting training, research or innovation.

However, we also found the following examples of good practice:

  • The quality of some nursing care plan updates was of a good standard, and in particular, those of the psychologists were comprehensive.

  • Medicines were stored securely in locked cupboards that were accessible only by the key holder or nurse in charge.

    Following the inspection, CQC formally requested under Section 64 of the Health and Social Care Act 2008, to be provided with specified information and documentation by 16 November 2018. We requested further information from the unit manager to be provided by 30 November 2018. We received some of the information requested but not all.

    Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with 22 requirement notices. Details are at the end of the report.

    Full information about our regulatory response to the concerns we have described will be added to a final version of this report, which we will publish in due course.

    Nigel Acheson

    Deputy Chief Inspector of Hospitals

7 - 8 June 2016

During a routine inspection

We rated The Glenside Hospital for Neuro Rehabilitation as good because:

  • Staff involved patients and their families in developing their care plans, and ensured that the patients risk assessment was linked into their care plan. These care plans were holistic and relevant for the patient. The hospital had implemented emotional wellbeing assessments.
  • Ward managers could adjust staffing levels to meet the clinical need of patients. The hospital used agency staff that were familiar with the ward and provided service specific training to ensure they could meet patient’s needs. The hospital had taken steps to manage staff turnover and staff morale was high.
  • The hospital had a wide variety of healthcare professionals and a wide range of facilities, including ample outdoor space, quiet waiting areas and phones that patients could use in private. Professionals used recognised rating scales to measure patient’s progress and discussed this in multidisciplinary meetings.
  • The majority of patients reported that they had received good care and reported positive staff attitudes. We saw that staff were positive and engaging when they spoke with patients. Staff helped to ensure patients had access to activities that were meaningful to them and they took steps to help patients feel comfortable when they were moving between wards in the hospitals. They also helped with patients discharge so that their needs would be met after their stay in hospital.

  • There were new clinical leads within the hospital and we saw that they had provided good leadership for staff. The hospitals had some robust governance systems that allowed managers to monitor performance and develop quality improvement plans to help ensure good quality care.

However:

  • We found that the rapid tranquilisation (the use of medicines to calm/lightly sedate the patient, reduce the risk to self and/or others and achieve an optimal reduction in agitation and aggression) policy was not always clear, and that staff could not demonstrate that they had completed physical observations following administering the medicines. In response, the hospital quickly changed the policy and issued further training to its staff to ensure compliance with national guidance.

  • Systems did not always ensure that relevant information was recorded. For example, that staff recorded that they had conducted physical health checks. Staff on Nadder ward had not logged some checks to say they had recorded the temperature of the medicines fridge.

23rd & 24th February 2015

During a routine inspection

Introduction

The Glenside Hospital for Neuro Rehabilitation is a specialist hospital for care and treatment of adults with acute and / or long-term neurological conditions including acquired brain injury. It is a 151 bedded independent hospital owned by Glenside Manor Healthcare Services Limited. The hospital is registered to treat detained and non-detained patients. Glenside has a number of different buildings some of which are hospital wards and some of which are care homes with and without nursing.

Type of services delivered

Acute services with overnight beds

Care home services with nursing

Care home services without nursing

Long term conditions services

Hospital services for people with mental health needs, learning disabilities and problems with substance misuse

Rehabilitation services

Regulated activities delivered

Accommodation for persons who require nursing or personal care

Assessment or medical treatment for persons detained under the Mental Health Act 1983

Diagnostic and screening procedures

Treatment of disease, disorder or injury

OVERALL SUMMARY

Glenside had made considerable progress in addressing the issues that had been raised previously on visits by the CQC. Staff were enthusiastic, caring and treated people with respect and dignity. They were supported by a proactive senior management team who were well thought of by the workforce. The hospital does need to consider how it provides clinical leadership in addition to the strong management structure they have created.

The hospital had addressed outstanding compliance actions from previous inspections.

The hospital is aware of the challenge of providing treatment services alongside social care settings within one registration. At the time of inspection the provider had applied to split the registration.

Although a high proportion of shifts were worked by agency staff, the hospital had been addressing this successfully. There was a good emphasis on developing the workforce and staff described a culture of listening. Safeguarding in the hospital was very good.

The care we observed was good. However there was a concern that patients in the care homes were not always able to access care provided by allied health professionals, in particular physiotherapy. This appeared to be a commissioning issue.  The hospital could also do more to address patient’s psychosocial needs. Staff worked hard to enable patients but the hospital did need to address the culture on one care home where although staff were caring, there were blanket restrictions in place.

The hospital had good facilities and patients were able to personalise their environment. However we were concerned that environmental risk assessments could be more robust and in particular that ligature risk assessments had not been completed.

Within the last year the hospital has undergone significant change with the appointment of a new chief executive officer and other senior management team members. The changes that they have made have resulted in a positive workforce and patients telling us that they think the care they receive is good.

2 July 2014

During an inspection in response to concerns

We carried out this inspection in order to follow up concerns about low staffing numbers and the potential effect of this on people's care. Concerns had been raised about care in more than one area of the hospital however the majority of concerns were raised about Pembroke Lodge. On this occasion we only inspected Pembroke Lodge.

We found that staff were caring and the staff we spoke with were able to tell us about individual patients and their needs. We found that while there were very large care plans in place for people, these had not always been updated and it was difficult to find clear information about people's care needs. People's needs were not always updated and there was a lack of information about people's emotional support needs. Medication profiles in people's care plans were not accurate.

Medicines were not kept safely. Supporting information for allergies was inconsistent for two people at the home. Supporting information was not available for creams and ointments, labelled 'to be used as directed' or 'how a person preferred to take their medicines' when taken by mouth.

Staff were positive about the new manager. We found that there were adequate numbers of staff on the unit however there was high use of agency staff. The provider was actively attempting to recruit new staff.

The provider had identified that governance and quality assurance systems had been inadequate and we saw an action plan in place to address this.

17, 18, 20 June 2013

During a routine inspection

The Glenside Hospital for Neuro Rehabilitation cared for people with impairments from neurological conditions or acquired brain injury. We were able to speak to a number of people who stayed or lived at the hospital, but some were not able to talk with us due to their neurological condition. We talked with some people's families and visitors and heard about their experiences of the service. We also observed care and support given to people by staff from different disciplines, such as therapists, nursing staff, and care workers. We talked with staff and senior managers at the hospital. We were accompanied on one day of our visit by a specialist advisor.

We found improvements had been made to medicines management and supporting workers, and although some work still needed to be continued and completed, the provider was now compliant with these essential standards.

We looked at other areas on this review. We found overall, people were treated with dignity and respect. Their needs were assessed by competent and caring staff. The care and support people were given was safe and effective and met their assessed needs. There was some work required to improve upon some care plans and records, but overall these had been much improved.

The organisation had continued to improve and enhance its governance system for assessing and monitoring the quality of the service. There were still some areas to be addressed to complete this work, but overall the system was robust.

Most staff felt supported by the organisation and enabled to perform their roles. Some staff needed a support framework to be developed for them, but this was known to the senior management and plans in place to cover this.

1, 4, 5 February 2013

During an inspection looking at part of the service

When we visited Glenside in August and September 2012 we found a number of the essential standards of quality and safety were not being met. The organisation provided us with a detailed action plan on how it would improve. We went back to Glenside on this visit to check those improvements.

We found the hospital had achieved compliance in four of the six areas where we had concerns on our last visit. We found there had been improvements in the management of medicines and the support of staff. However, these areas required further work to meet the standards required.

Patients we met who were able to talk with us told us they were well cared for. They said they got on well with staff and their assessed needs were being met. Patients said staff were kind and patient. A relative we spoke with said: 'my wife gets very well looked after. I have nothing but the highest praise. Staff are wonderful.'

We found most care plans were well written and relevant. Patients' physical, behavioural, and cognitive needs were being assessed and met. The hospital had made improvements to the safety and suitability of the premises. Staffing levels had improved, although the provider had not yet addressed the numbers and skill mix of staff against the assessed needs of patients. The organisation now had an effective system for assessing and monitoring the quality of the service.

30, 31 August and 3 September 2012

During a routine inspection

During our visit to The Glenside Hospital we met and talked with patients who were able to talk or communicate with us; their families and friends; and staff working in all areas of the hospital site. Many of the patients at the hospital were not able to communicate with us due to suffering a brain injury; living with a long-term cognitive impairment; or a form of dementia. However, we were able to talk with a number of patients who told us about their time at the hospital. One patient in the main hospital site told us: 'I like it here. They look after me fine. I'm treated fairly and I think I'm fair to them. I do quite a few jobs which I like doing'. Another patient in the hospital said of the staff: 'I think they are really good. They treat me with respect'. The patient also said it could be 'a bit boring' at times and they would like some more organised activities.

We met the families of both these patients. One family said 'when [the patient] leaves here, 'thank you' will not be enough'. Another family said, speaking about the staff: 'they have been really brilliant with [the patient]'.

We spoke with the relative of a patient who said: 'they have not just saved [the patient's] life, they've saved mine too'. One relative who was a frequent visitor said: 'on the whole, care has been really good and pretty near excellent most of the time'. We were told staff were patient and kind and moved and handled people safely and with care. The relative said privacy and dignity was 'very well done' and felt it was something the hospital ward in question took 'very seriously'.

Another patient in another part of the hospital which cared for people whose behaviour can be challenging told us they were well cared for and the staff were kind. This patient had many of their own personal possessions around them and it was clear this was important to them. In the part of the hospital that supported people living with a dementia, one patient told us: 'it's quite nice here. They look after me well. Staff are OK and the food is very nice'. Another patient said: 'the food is nice and we had beef casserole today, which was not bad at all'.

During our inspection we visited each area of the hospital site. We observed the majority of patients being treated with privacy and dignity. Patients and/or those who spoke for them were able to be involved in their care and patients were given an appropriate level of independence. We observed and saw evidence of a patient-centred approach in many areas of the site, specifically in the main hospital building.

The care and welfare of most patients was being delivered safety. Care plans were held for each patient and contained some good detailed information. However, we found some to be incomplete for some important clinical information.

During our visit, we witnessed and observed one event which gave cause for concern for the safety of a small patient group and the staff looking after them.

We had concerns over the safe use and storage of medicines in all areas and staff always providing them safely and knowledgeably.

The premises ranged in age and condition. Some buildings were old and had listed status. The older buildings had undergone some adaptation but there were parts that were now in an unacceptable condition. The newer buildings were purpose-built, well maintained with large rooms with a lot of natural light. The recently opened ward and the other ward being prepared for opening were decorated and fitted to a high standard. The hospital building was safe and mostly clean, although some areas were overlooked in cleaning routines. Most areas of the site were clean and tidy. However, there were issues in the main hospital building with enough storage space to meet hygiene and safety standards.

We met with the relative of a patient in one of the long-stay wards providing specialist nursing care. This relative was concerned about the amount of therapy being provided to the patient concerned, and how a complaint had been handled. They also had concerns over safe staffing levels and how this affected patient care. The hospital had calculated how many staff were needed (the establishment), and with what experience and skills, for each area of the hospital. However, we found most areas were understaffed at varying levels over the last three months. One ward was meeting the staffing establishment, but this was not enough to provide safe, effective cover. The event we witnessed at the hospital where we had concerns for patient safety also gave concerns for staff safety and the support they received. We were also concerned the staff were not adequately trained to deal with the patient group or patient mix they were required to support.

The provider organisation had a board of directors, chaired by the executive chairman. At the time of our visit there was no representation on the board from a clinical or medical perspective. There was no distinct leadership of either of the two divisions (hospital areas and care home areas), although the hospital management had recognised and was addressing this by new appointments. There were some performance targets for staff that had not been determined or considered by the board. Considering the event witnessed at the site during our inspection, the board was not able to assure us it had a system to continuously identify, analyse and review risks in order to keep patients and staff safe.

27 June 2011

During an inspection in response to concerns

We received information that there was a lack of staff and that staff were not supported, so we looked at these two areas during this review. Patients cared for at Glenside Manor, due to their acquired brain injuries have a difficulty in communication, so we observed their treatment and care and talked to staff.

We observed two staff talking to three patients in a small unit for people with brain injury. All five people were relaxed together, with the three patients being treated as individuals by staff. We did not observe anyone on any of the units showing signs of distress of needing to be supported in the management of their complex behaviours. Each of the units that we went to appeared to be busy, but door bells to units were answered very promptly by staff and as we walked around the units, staff were in evidence supporting people. We observed two therapists supporting a person with a mobility difficulty out in the campus grounds. They encouraged the person in what they were doing and made sure that they were safe.

Staff told us that there had recently been issues relating to both staffing levels and training. Our review showed that the provider is aware of these issues and is making much progress in ensuring that people's needs are met by sufficient numbers of staff, who have the skills needed, to meet their needs.