Archived: The London Treatment and Rehabilitation Centre

During our visit we spoke with 10 patients who were staying on the Centres 3 operational wards/units. This represents 50% of the people who are currently using the service. The feedback we received from most of the patients we met was on balance complimentary about the standard of care and treatment they were being provided at the Centre. Some of the typical comments made by patients we spoke with, included: 'Highgrove is the best mental health unit I have stayed on, and I can tell you that I have been on a few' and 'Staff are always nice and calm here'.

It was evident from the comments we received from patients that most felt they had opportunities to express their views, which were usually taken into account, and could get involved in making decisions about how their care and treatment was delivered. For example, most of the patients we spoke with told us they thought the information displayed on the notice boards on the wards helped them have a better understanding of the care and treatment choices available to them. Some of the patients we spoke with were also told us the provider had recently invited them to participate in a satisfaction survey to feed back their experiences about how the service was run.

On balance the feedback we received from patients we met was positive about care plans and their involvement in the care planning process. All 6 patients we spoke with about their care plans told us they had a care plan which they had read. Most of these patients also told us staff encouraged them to participate in the care planning process during meetings they regularly had with their designated key-worker.

All 10 patients we spoke with during our visit told us the opportunities they had to do more things for themselves had significantly improved in recent months because there was now a lot more occupational therapists on site to help them shop for their own food and to cook their own meals.

The feedback we received from the patients we spoke with about the opportunities they had to pursue interesting social activities both within the Centre and the local community was more mixed. While most of the patients told us they felt there were usually enough meaningful activities for them to engage in on the wards during the day, a few patients told us they would like more time to be made available to go on escorted leave in the local community. Some of the patients we met also felt there were not always enough staff on duty to support them with their pre-arranged escorted community leave or have a cigarette when they wanted.

However, most of the patients and staff we spoke with during our visit while acknowledging there had been issues with staff/patient ratios, which had affected the Centres ability to always meet all the patients community based activity and rehabilitation needs, most told us they felt the situation had significantly improved in the first quarter of 2012.

It was clear from the feedback we received from patients that on balance they felt the staff that worked at the Centre respected their privacy and dignity. Throughout the course of our visit we always observed the managers; nurses and care workers that were on duty at the time always interact with the patients in a kind, courteous and professional manner. Patients staying on the Highgrove Unit and Brooklyn Ward told us staff always knocked on their bedroom door to seek their permission before entering their private space. We also saw staff taking their time to actively listen to what the patients had to say to them and act accordingly.

Most of the patients we spoke with had only positive things to say about the overall attitude of the nursing and care staff that supported them on the wards. Some patients spoke about how staff had become increasingly more supportive and helpful to them in recent months. All the patients we met on the Highgrove Unit were particularly complimentary about the staff that worked there.

We found other evidence during our visit that showed us the people using the service are protected from abuse and/or neglect. Most of the patients told us they felt safe on the Wards or Units they stayed on at the Centre.

We spoke with 10 patients about the interior design and layout of the wards and the feedback we received was on balance complimentary about the overall standard of the Centres environment. Most patients we met told us that they were happy with the way their bedrooms were decorated and furnished.

Most of the patients we spoke with about the new Hospital Director told us they liked the way they were managing the Centre. However, most of these patients also expressed being dissatisfied with the management constantly changing.

During our visit we observed activities taking place and several patients spoke about the groups they did go to such as yoga, art and leisure. However, the majority of patients said not all activities took place as advertised. Comments included,

'Very nice ' art and yoga ' enough to do'.

'Full day ahead'.

'Boring on ward and half of activities don't happen as planned'.

'Activities don't happen as planned - no IT training as promised ' anger management group is intermittent'.

One patient told us they hadn't had a 1:1 for about a month and it took place at night as staff were busy working on the computer during the day; 'unless I say I want a 1:1, they don't interfere'. Another patient told us that their named nurse worked nights and wasn't timetabling 1:1s.

Two patients we spoke to raised the problem of access to fresh air. This is only possible during brief smoking breaks [2 staff required] and these take place in a small and poorly maintained garden. They said the large garden had not been used for several weeks for patients on one ward.

People we spoke to felt that their human rights, their dignity and privacy are respected, and that they are given appropriate choices about the care and treatment that they receive.

We asked people at the service about their care plans and the process of care planning in the unit. Some of the people we spoke to were aware of the care planning process and they told us they knew they had one, which most believed they could see if they wanted to by asking either their key worker or the ward manager. One person told us that they did not know what their care plan was though they were aware of a Care Programme Approach (CPA) meeting next week (a formal, regular and scheduled care planning meeting with all the key participants such as the person and their representatives or families, the care managers, ward staff and consultant psychiatrist) and that they would be involved in that CPA meeting.

However we were concerned that other people we not involved in the care planning process. For example, one person said they were given their care plan at 10.30pm at night and asked to sign it by a nurse who said, 'I've written your care plan - if you don't sign it and don't do what we tell you, that's up to you'. Similar comments included, 'I have a care plan but I would not sign it because it was not done with me and I didn't agree with what was in it'. 'I have a care plan, someone draws it up for me. They dictate to me exactly how I should be run. My opinion more or less does not count for anything'.

We also asked people if they understood their rights and had access to their solicitor and advocacy services. One person told us, 'Only seen solicitor once. Think you get an advocate. Told me about my rights when I first came in.' Another person said, 'know what section means, got information about my rights.'

Two people told us that there wasn't enough to do, but gave examples of activities such as yoga, painting, baking, current affairs group, horticulture, music group, trips to the sports centre for badminton, netball, football, and to the cinema or bowling at weekends.

Many of the people we spoke to talked about feeling they were under threat of their leave being curtailed if they were "naughty" or "kicked off on the ward" or did not take their medication. They expressed the view that leave was dependent on 'good' behaviour and that leave was withheld as a 'punishment'. For example people said,

'Just recently wrote out escorted leave. Its obvious staff don't like going out.'

"Get leave, can take it, but staff will take it away if kick off.'

One person told us that they 'Treat you like kids. Not reasonable.' Another raised concern that they were 'Becoming institutionalised'.

People who live at the service told us they regularly attend appointments with various health care professionals, including access to their doctors, dental services, and consultant psychiatrists. One person was visiting the dentist on the morning of our visit.

Most of the people we spoke to told us that they enjoyed the food provided on the unit. All of the people we spoke to told us that when they would like changes to the menu this is acted upon and changes to the menu are made. Other people told us that they participate in cooking sessions with the occupational therapist and got to cook and eat meals they enjoyed.

During our visit to the service we asked people about whether they felt safe living at the Ashwood Centre. The feedback we received was mostly positive and included comments such as, 'If I have a problem I tell my key worker', and [I] "feel safe on the ward'. One person said that they are able to raise issues at their meetings with staff as well as the informal dialogue that they are able to have with staff on a daily basis and with their key worker.

However other people told us, 'Staff turnover here is massive and it's difficult therefore to develop trust with the staff here because just as we get to know them they move on'. 'Don't feel safe on the ward, patients and staff keep coming up to me and pushing past me.'

People told us that they were generally happy with their rooms and that they are allowed to have some personal possessions that they want in their rooms. One person told us that they would like a table to sit at in their room. Two people also expressed a preference for laminate flooring in their rooms for personal reasons.