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St Magnus Hospital and St Magnus Nursing Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 16 March 2020

This service was inspected using CQC's methodology for inspecting both mental health and adult social care services. The report has been structured to provide an overall rating for the whole location and includes our rating for the low secure wards at St Magnus and older peoples services at both St Magnus and Rosemary Park Nursing Home..

We rated the St Magnus and Rosemary Park as Outstanding overall because:

  • There was a truly holistic approach to assessing, planning and delivering care and treatment to all patients who used services. This included addressing, mental health and physical health care needs along with their nutrition, hydration and well-being needs. All care plans were personalised, holistic and recovery focused. It was clear from the content of the care plans that patients and their carers had been involved in developing the plans. All patients were risk assessed on admission and had up to date risk assessments which were linked to their care plans

  • Staff used safe, innovative and pioneering approaches to care. There were individual and group psychological therapies such as cognitive behavioural therapy and dialectical behavioural therapy available to assess and provide treatment and there was a dedicated psychologist in post to ensure psychological evaluation was happening

  • Staff across both services used an “all about me” document which was kept in the patient bedrooms for patients who had cognitive difficulties to help inform staff of patients’ likes and dislikes. This document was detailed and informative and gave all staff an opportunity to engage with patients in areas of interest

  • The majority of patients were detained under the Mental Health Act 1983 (MHA) and understand and were empowered to exercise their rights under the Act. The provider supported staff to understand and meet the standards in the MHA Code of Practice. The service had developed a system for ensuring patients supported on a Deprivation of Liberty Safeguards (DOLS) applications were fully tracked and they had their rights and entitlements explained to them and recorded regularly.

  • Practices around consent and records were actively monitored and reviewed to improve how patients were involved in making decisions about their care and treatment.

  • Staff were clear about their safeguarding responsibilities to ensure they kept patients safe and knew how to identify and make a safeguarding referral within office hours and during the evening and weekend.

  • The services supported health care assistants to complete the care certificate standards and senior healthcare workers were offered the opportunity to complete their Nurse Associate training funded by the hospital.

  • Feedback from patients and their carers and stakeholders was overwhelmingly positive about the way staff treated patients. NHS England commissioners reported witnessing a high level of compassion and understanding when they attended the hospital and reported that the clinical teams took a great deal of time and effort to ensure that the patients were involved in the process as fully as possible. Carers told us that they felt patients were safe, cared for and well looked after by staff. Staff attitude was described as caring, motivated and patients and carers told us that staff went the extra mile to ensure patients’ needs were met.

  • All staff across the service were observed to be exceptionally and consistently caring and respectful to all patients. Staff used thoughtful, appropriate and considerate language and adapted their style of communication to the patients’ level of understanding. We saw staff always responded quickly to patient requests for additional support such as personal care. Staff were passionate about their work and it was clear they genuinely cared about the emotional wellbeing of their patients and wanted them to feel cared for.

  • All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking and peer review were proactively pursued, including participation in approved accreditation schemes. High performance had been recognised as St Magnus Hospital is a member of the Quality Network for Forensic Mental Health Services (Royal College of Psychiatrists). St Magnus Low secure unit was found to have fully met 92% of standards, putting it in the top ten low secure units in the network.

  • Managers, with support from the security lead, completed ligature audits to identify ligature points throughout the wards and gardens. In addition, daily walk-around checks and a weekly environmental check on each ward ensured a regular systematic approach to maintaining a safe environment.
  • The ward and unit environments at both St Magnus and Rosemary Park were clean and well maintained. Staff followed good infection control procedures and monitored the cleanliness of the environment regularly through conducting audits. The design, layout, and furnishings of the ward/service supported patients’ treatment, privacy and dignity. In St Magnus hospital each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. Across the whole service there were quiet areas for privacy. The bedrooms had been personalised. Carers had supported staff to personalise bedrooms on the wards for patients with dementia.
  • The food was of an excellent quality and patients could make hot drinks and snacks at any time. The patients were complimentary regarding the kitchen’s ability to meet their individual food choices

  • Staffing levels and skill mix were planned, implemented and reviewed to keep patients safe at all times. Any staff shortages were responded to quickly and adequately. Registered nurses were visible on the wards and able to spend time with patients on the wards and 1:1 sessions were taking place. At Rosemary Park we observed staff were busy but not rushed, and patients told us call bells were answered quickly when pressed.

  • Training was managed with the support of the hospitals own dedicated education department in the hospital. Staff were up to date with all their mandatory training and could also access specialist training to support them to deliver good quality care. Support staff were supported to undertake nurse training if they wished.

  • Use of rapid tranquilisation was low across all wards at St Magnus and staff were using verbal de-escalation skills to ensure that patients’ distress was managed before it required additional medicine
  • Both St Magnus and Rosemary Park were able to meet the needs of all patients who used the service – including those with a protected characteristic. Staff helped patients 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. Patients told us that they did not have a need to complain. However, they were confident that if they did they would be listened to and the matter dealt with. Families confirmed that there was little need to complain about anything. Staff confirmed that they received feedback from incidents and complaints and that lessons learnt from other wards was shared with them at team meetings, via emails and within supervision and team days.

  • 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 patients and staff. Staff consistently reported that managers were supportive and would listen and act on any concerns they raised. Staff felt that the management team were more of a family and nurtured and supported the staff to progress within their roles.

  • 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 felt able to raise concerns without fear of retribution. Staff morale was high, and staff told us they were happy in their roles. We observed supportive and cohesive team working and the atmosphere appeared relaxed and encouraging.

However:

  • Not all staff at St Magnus had access to the electronic patient record. Junior support workers did not have access to the electronic record and could only view them if a member of staff with access login for them. This meant there was a paper copy of care plans and an electronic copy which required updating every time a care plan was reviewed which could lead to confusion within the staff team.

Inspection areas

Safe

Good

Updated 16 March 2020

Effective

Outstanding

Updated 16 March 2020

Caring

Outstanding

Updated 16 March 2020

Responsive

Good

Updated 16 March 2020

Well-led

Good

Updated 16 March 2020

Checks on specific services

Forensic inpatient or secure wards

Good

Updated 16 March 2020

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients

    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 patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team

    .

  • High performance had been recognised as St Magnus Hospital is a member of the Quality Network for Forensic Mental Health Services (Royal College of Psychiatrists). St Magnus Low secure unit was found to have fully met 92% of standards, putting it in the top ten low secure units in the network.

  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

  • The service was well

    -

    led

    and the governance processes ensured that ward procedures ran smoothly.

However:

  • A small number of staff

    were allowed to

    work

    excessive hours without

    taking regular days off

    H

    andovers

    did not take place during regular working hours

  • The patient bedroom window restrictors were not included in the ligature point audit
  • A small amount of equipment was out of date in the clinic room.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 13 January 2016

Wards for older people with mental health problems

Outstanding

Updated 16 March 2020

  • The ward environment was clean and infection control was well managed. The wards had cleaning schedules and regular audits for cleanliness were undertaken by the housekeeping department.

  • We saw clear evidence that all patients were risk assessed on admission and had up to date risk assessments which were linked to their care plans

    . The staff were exceptional at ensuring that all care plans were personalised, holistic and recovery focused. It was clear from the content of the document that patients and their carers had been involved in developing the plan.

  • Use of rapid tranquilisation was low across all wards and staff were using verbal de-escalation skills to ensure that patients’ distress was managed before it required additional medicine

  • Staff were clear about their safeguarding responsibilities and knew how to identify and make a safeguarding referral within office hours and during the evening and weekend.

  • There were individual and group psychological therapies available to assess and provide treatment In line with national guidance. There was a dedicated psychologist in post to ensure all diagnostic formulation work was happening

  • The service invested heavily in trained health care assistants by supporting them to complete the care certificate standards and senior healthcare workers were offered the opportunity to complete their Nurse Associate training funded by the hospital.
  • All staff across the service were observed to be exceptionally and consistently caring and respectful to all patients. Staff used thoughtful, appropriate and considerate language and adapted their style of communication to the patients’ level of understanding.

  • Carers reported that they felt patients were safe, cared for and well looked after by staff. Staff attitude was described as caring and motivated and carers felt staff went above and beyone to suport tyheir loved ones.

  • Staff could give multiple examples of the type of person-centred support that individual patients needed and how they met their needs. Staff were very passionate about their work and it was clear they genuinely cared about the emotional wellbeing of their patients and wanted them to feel cared for. Staff consistently used their in-depth knowledge of the patients to engage with them whilst recognising personal choice.

  • The design, layout, and furnishings of the ward/service supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an

    en

    -suite bathroom and could keep their personal belongings safe.

  • The food was of an excellent quality with multiple healthy choices. and patients could make hot drinks and snacks at any time. The patients were complimentary regarding the kitchen’s ability to meet their individual food choices

  • 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.

  • 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 patients and staff.

  • 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. Staff reported high morale and were happy in their roles. We observed supportive and cohesive team working and the atmosphere appeared relaxed and encouraging.

  • Governance processes operated effectively at ward level and that performance and risk were managed extremely well. All board assurance reports, safety reports and policies were scrutinised by and authorised by the SMT.

  • Staff reported multiple opportunities for professional development and that training was appropriate to their needs. This was echoed by the large training department who had already arranged opportunities for mandatory and patient specific training in the next year. Staff reported many opportunity to progress within the service. The culture of developing their own nurses was evident within several of the wards where support workers were being developed to undertake their nurse training.

  • Staff confirmed that they received feedback from incidents and complaints and that lessons learnt from other wards was shared with them at team meetings, via emails and within supervision and team days.

However:

  • Not all staff had access to the electronic patient record. Junior support workers did not have access to the electronic record and could only view them if a member of staff with access login for them. This meant there was a paper copy of care plans and an electronic copy which required updating every time a care plan was reviewed.

  • We found a small number of missed medicine doses that staff had not signed as being given.