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Inspection Summary


Overall summary & rating

Good

Updated 30 August 2019

We rated Healthlinc House as Good because:’

  • The service had enough nursing and medical staff, who were able to keep patients safe from avoidable harm and abuse. Staff assessed and managed risks to patients and themselves well and achieved the right balance between maintaining safety and providing the least restrictive environment possible to facilitate patients’ recovery. The service was a strong advocate of the STOMP program (stopping over medication of people with learning disability). Staff carried out thorough physical and mental health assessments of all patients on admission. Staff reviewed care plans regularly with the patient and their family or carers, care plans reflected the assessed needs, were personalised, holistic and recovery-orientated. Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice.
  • The staff team included or had access to the full range of specialists required to meet the needs of patients. Managers made sure staff had the range of skills needed to provide high quality care. Staff worked well together and understood their roles and responsibilities under the Mental Health Act 1983, and Mental Capacity Act 2005. Staff treated patients with compassion and kindness. Patients had a core care team to ensure that on every shift there was always at least one member of staff that they knew working with them. Staff understood the individual needs of patients and supported patients to understand and manage their care, treatment and condition. Staff and managers had gone the extra mile to ensure that patients could maintain links with their families who lived some distance away. Most carers we spoke with said staff kept them informed of their relatives care and treatment and involved them appropriately.
  • Staff planned and managed patient discharge well, as a result, staff rarely delayed discharge for other than a clinical reason. Each patient had their own en suite bedroom, within an apartment, and could keep their personal belongings safe. The service treated concerns and complaints seriously, investigated them and learned lessons from the results.
  • Managers had created two new key posts to address specific issues. A physical care co-ordinator to work closely with the consultant psychiatrist and visiting general practitioner. An employee engagement lead to buddy new healthcare assistants during the first few months of working at the hospital. The provider had made significant progress towards addressing the concerns raised in our previous inspection report. The provider had produced a quality assurance action plan and had engaged well with CQC to bring about positive changes to their service. There was a culture of mutual respect between managers and staff and patients.

However:

  • The decoration and furnishings were dated and tired, and there was some outstanding maintenance work in two apartments that had potential risk for patient safety. Signage around the hospital was poor. We found a disused telephone in the communal corridor with a cord wrapped around it, this had not been removed and staff had not included this on the ligature audit.
  • We could not substantiate the providers data showing compliance with supervision was 78%. We could not access enough supervision records to confirm the data. The processes for recording and storage of supervision records were not clear, many staff we spoke with told us supervision was inconsistent, and only two staff knew of the providers new supervision passport. Supervision had been the subject of a requirement notice following our last inspection.
  • Staff had not updated two of the seven patient risk assessments we reviewed following a recent incident. Though we saw evidence in the shift handover notes and multidisciplinary team meeting minutes, that the associated risks had been discussed. The providers allocation systems caused delays with new staff getting password access to the electronic patient data system.
  • Two carers told us staff had not returned their telephone calls or e mails when requested, nor had they given them minutes of their relatives care planning meetings.
Inspection areas

Safe

Requires improvement

Updated 30 August 2019

We rated safe as requires improvement because:

  • The decoration and furnishings were dated and tired. There was some outstanding maintenance work in two apartments, works included a badly positioned toilet causing the patient to have to sit sideways, and sharp edges on mirrors in the apartment. We found a disused telephone in the communal corridor with a cord wrapped around it that had not been removed, this was not on the ligature audit though staff we spoke with knew it was a risk “hot spot”. We advised the managers at the time and they assured us this would be dealt with as a matter of urgency.
  • Staff had not recorded the updated risks in two of the seven risk assessment documents we reviewed, following a recent incident. Though we saw evidence they had discussed amended risk management plans in the multidisciplinary team meeting notes and the daily handover notes.

However:

  • Staffing levels allowed patients to have regular one-to-one time with their named nurse. Staff shortages rarely resulted in staff cancelling escorted leave or hospital activities. There were enough trained staff to carry out physical interventions including observations, restraint, and escorted leave safely.
  • Staff mostly assessed and managed risks to patients and themselves well and achieved the right balance between maintaining safety and providing the least restrictive environment possible to facilitate patients’ recovery. Staff had the skills required to develop and implement good positive behaviour support plans and followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint only after attempts at de-escalation had failed. The service did not use seclusion. Staff participated in the provider’s restrictive interventions reduction programme.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s physical health. They knew about and worked to achieve the aims of the STOMP programme (stopping over medication of people with a learning disability).
  • The hospitals had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Effective

Good

Updated 30 August 2019

We rated effective as good because:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were personalised, holistic and recovery-orientated.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. This included access to psychological therapy, to support for self-care and the development of everyday living skills, and to meaningful occupation. Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives.

  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.

  • The team included or had access to the full range of specialists required to meet the needs of patients. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, and opportunities to update and further develop their skills. Compliance with staff annual appraisal, and doctor’s revalidation was 100%.

  • Managers provided a comprehensive induction programme for new staff, and agency staff who had completed a minimum of twelve shifts at the hospital and who intended to continue working at the hospital.

  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The team had effective working relationships with staff from services that would provide aftercare following the patient’s discharge and engaged with them early in the patient’s admission to plan discharge.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act code of practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.
  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

Caring

Good

Updated 30 August 2019

We rated caring as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.

  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.

  • We heard how staff and managers had ensured that patients could maintain links with their families who lived some distance away. Including offering to pay transport costs for one family to visit the hospital, and for another patient to have a three to one escort so they could go to visit their family.

  • Four carers we spoke with said staff kept them informed of their relatives care and treatment and involved them appropriately.

    However:

  • Two carers told us staff had not returned their telephone calls or e mails when requested, nor had they given them minutes of their relatives care planning meetings.

Responsive

Good

Updated 30 August 2019

We rated Responsive as good because:

  • Staff planned and managed patient discharge well. They liaised well with services that provided aftercare and were assertive in managing the discharge care pathway. As a result, patients did not have excessive lengths of stay and staff rarely delayed discharge for other than a clinical reason.
  • The design, and layout, of the hospital supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.
  • The service had a food hygiene rating of 4, and patients told us the food was of a good quality. Patients had access to or could make hot drinks and snacks at any time.
  • The hospital met the needs of all patients who used the service including those with a protected characteristic. Staff helped patients with communication and supported them to access 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.

However:

  • Signage around the hospital was poor. Some patients and new staff had told us it was easy to become lost and disorientated in the numerous corridors. Managers told us they would include this as part of their refurbishment plans.

Well-led

Good

Updated 30 August 2019

We rated well-led as good because:

  • 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 knew and understood the provider’s vision and values and how they applied in the work of their team.

  • Staff told us they had noticed significant improvement during the last eight months, about how managers interacted with them. They reported that the provider promoted equality and diversity and provided opportunities for career progression. Staff felt able to raise concerns without fear of retribution.

  • There was a culture of mutual respect between managers and staff and patients. Most staff reported they felt respected, supported and valued.

  • Our findings from the other key questions and our close monitoring of the providers action plans, through the engagement process, demonstrated that governance processes operated effectively, and managers managed performance and risk well.

  • Staff engaged actively in local and national quality improvement activities, and innovation.

  • Staff had access to the information they needed to provide safe and effective care and used that information to good effect.

    However:

  • The providers allocation systems caused delays with new staff getting password access to the electronic patient data system.

  • The processes for recording and storage of supervision records was not clear. CQC had reported supervision as a requirement notice following the last inspection. Managers explained that supervision process was an item on their quality assurance action plan and they were addressing the issue by introducing new supervision passports and guidance for supervisors.
Checks on specific services

Wards for people with a learning disability or autism

Good

Updated 30 August 2019