Battersea Bridge House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Key Question Score: 20 (63%)

Key Question Rating: Good

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question as requires improvement. At this inspection, the rating has changed to good.The service was in breach of regulation in relation to safe care and treatment. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have consistent practice of safety in which concerns about safety were listened to, safety events were investigated and reported thoroughly, and lessons learned to identify and embed good practices.

Staff knew what incidents to report and how to report them using the electronic reporting system. Where lessons learned were identified, these were shared with staff during staff meetings and via email. However, staff did not always fill in the incident forms with sufficient detail. We looked at a sample of four incidents and saw that in one form, there was not enough detail about the positioning and length holds of staff during a physical intervention. In three forms, the section about lessons learned was not completed.

Staff said that both staff and patients received a debrief after an incident. We saw that these debriefs were not consistently recorded in the incident reporting document.

Staff discussed incidents and lessons learnt in a number of forums, including supervision, daily huddles and team meetings. Staff were debriefed after incidents by managers and psychologists, and an employee helpline was available for additional support.

Patients were able to raise concerns, provide and receive feedback on issues that impacted them.

The service worked with people and partners to establish and maintain safe systems of care and to ensure continuity of care when people moved between different services. However, there were some challenges due to circumstances outside of the staff’s control.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge.

Care records detailed multidisciplinary input in the care and treatment of individual patients. The daily multidisciplinary meeting included a range of professionals who contributed to discussions and decisions taken. Staff referred patients to external agencies when required, including GP, accident and emergency departments and hospitals.

Staff told us there were sometimes challenges in planning discharges, for example due to local funding and accommodation issues. This could cause significant delays to some patients being discharged safely, with a detrimental effect on their well-being. Staff liaised regularly with external services in order to overcome these challenges for individual discharges.

The service worked with people to understand what being safe means to them as well as with partners on the best way to achieve this. Staff supported people’s right to live in safety, free from avoidable harm and made sure they shared concerns quickly and appropriately.

The service had a number of systems in place to protect people from harm. The service had policies for safeguarding children and adults. Safeguarding was part of induction for new staff and ongoing mandatory training. Most eligible staff had completed mandatory safeguarding training. Safeguarding was discussed in variety of forums, including daily and weekly meetings, ward meetings, handovers and clinical and managerial supervision.

Most staff could describe how to identify a safeguarding concern and what to do about this, but we noted that support workers could not describe how to identify different types of abuse as well as other groups of staff and would benefit from more in-depth training on this.

Staff could describe how to make a safeguarding alert, and we saw that this took place when appropriate.

Staff followed safe procedures for children visiting the service.

The service did not always work with people to understand and manage risks so that care met their needs, in a way that was safe and supportive and enabled them to do the things that matter to them.

Staff completed a risk assessment with every patient on or soon after admission. Staff discussed individual patient risks at a multidisciplinary team meeting each week. Patients attended parts of this meeting and had an input to risk discussion.

Whilst risk was identified and staff communicated verbally about how to manage them; management plans were not always well evidenced in records. We did not find evidence of staff completing clear risk management plans for patients.

Staff completed care plans relating to individual identified need and discussed each patient at daily handovers and huddles. This included discussion of risks, behaviours and actions. In discussions with staff, staff had an understanding of individual patient needs and risks.

An interpreter service was available and could be used if required. Staff told us that they had a diverse group who were able to speak different languages and could translate for the patient where required.

Patients were able to contribute and make suggestions which were listened and responded to.

Carers’ feedback was listened to and welcomed by the service. Most carers we spoke to said that they could give feedback where required.

Staff reviewed observation levels regularly and updated patient records when these changed.

Staff ensured the patients could access advocacy. A patient we spoke with told us they knew how to access an advocate.

The service detected and controlled most risks in the care environment and made sure that the equipment and facilities supported the delivery of safe care.

Staff completed regular risk assessments of the care environment. This included ligature risks and any maintenance issues. Staff could not see all areas of the ward from the office, but this was managed through the use of convex mirrors, staff presence in the communal areas and general, hourly observations.

Staff had completed a ligature risk assessment of all areas of the ward. They had introduced collapsible items in on suite bathrooms and we're in the process of adding these items to the risk assessment. Staff were aware of these items and necessary mitigations.

Wards were single sex and there was no mixed sex accommodation.

Staff had easy access to alarms and patients had access to nurse call wall alarms in their bedrooms.

The hospital was in a residential area with residential flats close by. All windows had either a reflective film on the outside or a frosted film that could not be seen through, to ensure privacy. The service had identified that the reflective film was better, as it allowed patients to see out of the windows, which the frosted film did not. The service was in the process of replacing all frosted film with this reflective film instead.

Blake Ward had a seclusion room. This allowed clear observation and two-way communication. There was a toilet and sink facility in the room but there was not a shower that patients could use. Access to a bathroom with shower was facilitated for a patient in seclusion. Patients could see a clock with the time and date through the viewing panel of the seclusion door. There was a mattress and anti-ligature blankets available in the room. Staff were able to control the temperature of the room.

Patients were able to raise concerns about the safety of the ward environment in their meetings with staff.

The service displayed a list of prohibited items and followed a policy which detailed when routine and exceptional searches were to be conducted. The search area was in a designated room.

The service had enough qualified, skilled and experienced staff who received effective support, supervision and development. However, the service did not ensure that all groups of staff were up-to-date with mandatory training and supervision.

The service calculated the number and grade of nurses and support workers required depending on the number of patients. The ward managers could adjust staffing levels daily to take account of case mix and observation levels. At the time of inspection, the service was not using agency staff.

Staffing levels were calculated to ensure patients had regular one to one time with their named nurse. Staff told us they had time to do these regularly and record them on the system. Staff said they were able to take the brakes as needed.

There were enough staff to carry out physical interventions safely and staff had been trained to do so. At the time of inspection, the provider was updating its restrictive practice training from one type to another, which emphasised minimising restrictive practise as much as possible.

The service used engagement and observation as a tool to manage patient risk. Staff could clearly describe different levels of observations, how to carry these out and how to record them. Records showed that staff completed checks in line with national guidance, such as four times within an hour, rather than exactly every 15 minutes.

At the time of our inspection, there was no open staff vacancies.

A patient we spoke with said there were enough staff on the ward.

The medical staff we spoke with said there was adequate medical cover day and night, and a doctor could attend the ward quickly in an emergency. A patient told us doctors always seemed available if they needed to speak to them.

Staff received training appropriate to their roles to enable them to support the patient group using the hospital and most were up to date with their training. Managers monitored training compliance rates in supervision and team meetings. The completion rate of one mandatory training course was low. Breakaway training completion was 73.53% for eligible staff.

Most staff participated in supervision and appraisal; however, rates were significantly lower for the month of January (62%) and May (85%).

Staff could access reflective practice sessions, supervision, debriefs and said that learning was shared well following incidents. New starters received a role-specific induction, and managers used a checklist to ensure they had completed it prior to starting work.

Leaders explained their processes to ensure staff were suitably qualified and had appropriate employment checks.

The service assessed and managed the risk of infection appropriately.

All ward areas were clean, had good furnishings and were well maintained.

The care environment on both wards was visibly clean, mostly well-maintained and appropriately furnished. A patient we spoke with told us they found the ward clean. However, another patient we spoke to said that the environment was dirty and unkept at times.

Staff adhered to infection control principles, including hand washing, which was audited by managers. Staff maintained equipment well and kept it clean we saw clean stickers visible and in date on equipment.

Patients were able to give feedback on the environment and raise any issues with staff members. Cleaning records were up to date and demonstrated that all areas of the ward were cleaned regularly. Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date. Clinical equipment was cleaned regularly and after each use.

The service did not always make sure that medicines and treatments were administered safely, in a timely way or in line with national recommendations or legal authorisations. Monitoring was not completed to ensure patients were kept safe following use of rapid tranquilisation medicines.

We found some areas of medicines management that could be improved.

PRN (‘when required’) medicines were prescribed by the doctor for the management of anxiety and/or agitation for patients at the service. The doctors usually included whether a medicine should be used as a first or second line. Records we reviewed showed that where the decision to use the second line as the initial treatment was made staff rarely were recording why they had made this decision. Similarly, some staff were recording they were using PRN medicines for a reason other than that indicated on the prescription. There was no record to show that this was discussed with the medical team. We were not assured that the medicines were always being given as the prescribers intended.

For people started on the anti-manic medicine sodium valproate, we could not find evidence that prescribers had discussed the risks of this with the patient prior to initiating treatment as recommended in MHRA (Medicines and Healthcare products Regulatory Agency) guidance.

For one person we found that staff had failed to give rapid acting insulin in line with the current diabetic care plan. We could not be assured that staff had managed that person’s insulin in a way that managed their condition effectively.

Whilst there was a process in place to ensure staff recorded the site of injection, batch number and expiry date for long-acting antipsychotic injections being given, we found staff were not consistently recording this information. Failure to properly rotate the site of an injection can lead to damage to the area.

We also found some areas of good practice.

Medicines were stored safely and securely.

The service made use of an electronic prescription and medicines administration system to record when medicines were given and this could support staff to give medicines safely.

Staff we spoke to were knowledgeable about medicines optimisation and management. Staff ensured they were giving medicines in line with the relevant Mental Health Act consent to treatment authorisations.