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Reports


Inspection carried out on 02 and 03 July 2019

During a routine inspection

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 carried out on 8 - 10 May 2017

During a routine inspection

We rated Heathlinc House as good because:

  • Managers discussed staffing levels daily in the morning management meeting and deployed staff to take into account individual patient need and risk. We saw that a qualified nurse was often in the communal areas of the service, although a support worker was present in the communal areas at all times.
  • Medicines were stored securely and in accordance with the provider policy and manufacturers’ guidelines. We reviewed eight prescription charts which were completed correctly. Each chart had a “use of as required medication protocol” form which gave direction on when to administer as required medication as well as guidance to staff for reporting issues to the prescriber.
  • Staff treated patients with kindness, compassion and respect. We observed interactions between staff and patients and saw that staff were responsive to patient's needs. We observed support given to patients at meal times. Staff treated patients with dignity and were caring. Staff interacted with patients at a level that was appropriate to individual needs.
  • Doctors followed National Institute for Health and Clinical Excellence (NICE) guidelines when prescribing medication. We reviewed eight medication charts which showed that antipsychotic prescribing met with NICE guidelines. Patients had access to psychological therapies recommended by NICE. These included the use of functional assessments to identify behaviours that challenge, dialectical behaviour therapy and the use of positive behavioural support plans.
  • Patients knew how to complain. The hospital displayed pictorial information on how to make complaints. We spoke with eight patients, all of which said they knew how to complain.
  • Staff were aware of how to manage complaints. Staff we spoke to knew the complaints process and was able to respond appropriately and support patients to make a complaint if required.

However:

  • Staff did not record room temperatures of all clinic rooms. We found several gaps in the recordings for clinic room two. This could have affected the efficacy of the medication stored in the room.
  • Managers had not ensured that polices were kept up to date. We reviewed 10 hospital policies, all of which had expired; the date for review was February 2014. We brought this to the attention of the managers who assured us policies were adhered. The manager provided an action plan which highlighted that all polices would be updated by August 2017.

Inspection carried out on 06 and 15 January 2016

During a routine inspection

Overall we rated Healthlinc House as requires improvement because:

  • there were 58 instances of missed signatures against some prescribed medications, meaning we could not be assured patients had been given their medication as prescribed
  • the use of agency staff was high and staff and patients said agency staff did not always understand the specific needs of the patients
  • cleaning fluids were not securely stored in line with the Control of Substances Hazardous to Health Regulations 2002
  • the automated external defibrillator and suction machine were not serviced on a regular basis
  • in the seven care records reviewed, one patient’s record did not contain a completed risk assessment
  • only two records seen showed that patients had a physical healthcare check completed by the doctor on admission
  • support staff told us that outcomes from multidisciplinary team meetings and contents of patients’ risk assessments were not communicated to them
  • 23% of staff had not received supervision within the past three months
  • 33% of staff had not received an annual appraisal within the past twelve months

However:

  • the environment was clean and tidy, in a good state of repair, suitable for care and treatment, and risk assessed
  • robust systems enabled staff to report incidents
  • patients’ needs were assessed and care and treatment was planned to meet identified needs
  • patients received regular one to one time with their named nurse and there was evidence of this in the care records
  • staff appeared kind with caring and compassionate attitudes, and engaged with patients in a kind and respectful manner
  • activities were available for patients’ specific needs, including arts and crafts, cooking, big breakfast club and trips out

Inspection carried out on 18 July 2013

During an inspection to make sure that the improvements required had been made

During our previous visit in April 2013 we said the provider must improve the way they gained patient’s consent to care and treatment, and how they assessed people’s capacity to consent. This was in relation to those patients who were not subject to any restrictions under sections of the Mental Health Act, 1983.

We visited again in July 2013 to review the actions the provider had told us they would take.

We saw there were clear systems in place to assess patients’ capacity to consent to their care and treatment. The systems included information about advanced decisions, arrangements for acting in patients’ best interests and any input from advocates.

Inspection carried out on 16 April 2013

During a routine inspection

When we visited 35 patients were receiving care and treatment within the hospital. 28 of the patients were detained under various sections of the Mental Health Act, 1983.

During our visit we spoke with two patients, five members of staff, a clinical manager and the registered manager for the hospital.

We looked at five patient’s care records in detail and other records kept within the hospital such as staff recruitment and training records. We also spent time observing how patient’s were supported to receive their care and treatment.

Patient’s had individualised care plans and received the care and treatment set out in those plans. For some patient’s there was no documentation about their capacity to consent to care and treatment, or records to show they had been asked for their consent. This meant the provider could not be sure they were acting in accordance with patient’s wishes or in their best interests. We said the provider must take action to address this issue.

Staff were recruited to work within the hospital in a way which promoted patient's safety. They had received training in subjects which helped them to meet patient’s needs.

Patients we spoke with told us they were generally happy living at the home. One patient told us staff helped them to join in with activities they enjoyed and another patient told us staff listened to what they had to say. Patients also said they felt safe living within the hospital.

Inspection carried out on 28 November 2012

During an inspection to make sure that the improvements required had been made

During this visit we followed up on three areas of non-compliance identified in a previous inspection. We reviewed evidence that demonstrated the provider's compliance in these outcome areas.

We spoke to one person who lived at the hospital and they told us about how staff helped them to manage the risks involved with their care.

Inspection carried out on 13 August 2012

During a routine inspection

We spoke with a number of patients within the hospital, and we also used a range of different ways to help us understand their experiences. This was because some patients had complex needs which meant that they were not able to tell us about their care and support experiences. For example, we looked at records, including personal care plans, we spoke to the managers and staff who were supporting patients, and we observed how they provided that support.

We saw patients were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect. The quality assurance systems that were in place encouraged patients to express their views about the services they received, and be involved in improving the services where necessary.

In general we saw that patients were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the hospital.

Patients told us things like, “My key worker is nice, she helps me a lot”, “Yes I feel very safe, the staff are nice here” and “I would speak with the manager if I was worried about anything.”

However we saw that there were areas where the provider needed to make improvements to the service that patients received. For example, we identified issues with medicines management, management of moving and handling needs, and the general hospital environment.

Inspection carried out on 10 November 2011

During a themed inspection looking at Learning Disability Services

There were 41 patients at Healthlinc House when we visited. We met most of the patients and spoke to five of them in more depth to get their views of the service.

The patients we spoke with were positive in their views. They told us they were involved in planning and reviewing the care and support they needed. Patients said that staff were “kind and polite” and had helped them to move on. They told us about the range of activities they enjoyed. Patients told us they felt safe at Healthlinc House.

Reports under our old system of regulation (including those from before CQC was created)


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.