Fir Trees Independent Hospital

Updated 19 February 2024

Fir Trees provides services for male and female patients with mental health needs who require mental health rehabilitation. It is managed by the Alternative Futures Group which is a registered charity who have several other mental health hospitals and community services within the northwest of England.

Fir Trees is a 14-bed hospital and provides rehabilitation to both patients detained under the Mental Health Act and informal patients. It provides community-based inpatient mental health rehabilitation.

There was a registered manager in post at the time of our inspection, a controlled drugs accountable officer and a nominated individual for this location.

The service is registered to provide the following regulated activities:

• assessment or medical treatment for persons detained under the Mental Health Act 1983,

• treatment of disease, disorder and injury, and

• diagnostic and screening procedures.

The local clinical commissioning group block purchase all the beds and only those within the Wigan area can receive treatment.

Fir Trees was last inspected in February 2018. On that inspection, we rated Fir Trees as good overall. We rated effective as requires improvement and the other 4 key questions (safe, caring, responsive and well-led) as good.

The last report stated what action the provider should take to improve. These were as follows: -

• There were no psychologists working into the service. We did not find any evidence of psychological interventions being provided to the patients as part of their rehabilitation and recovery care pathway.

• There was no evidence to show if patients had been given copies of their care plans or if they had refused a copy.

• Section 17 leave forms were not fully completed. The outcome of leave was not being recorded.

Staff ensured ratings were displayed in a prominent place as required. The provider has a duty to ensure CQC ratings are displayed appropriately so patients, visitors and the public can easily see the hospital’s ratings. On this inspection, we found that the current ratings were displayed on the provider’s website. The current ratings were also displayed near the hospital’s reception area.

What people who use the service say

We interviewed all eleven patients and 5 carers, all of whom were positive about the politeness and respectfulness of staff. They spoke positively about staff who they worked with. Staff were described as supportive, kind, respectful and caring.

All carers described the hospital as the best they had been involved with.

However, after the inspection we received a comment from a patient who raised concerns regarding the lack of activity and criticised the attitude of one staff member.

Updated 19 February 2024

Our rating of this service stayed the same. We rated it as good because:

• The hospital environment was safe and clean.
• Staff assessed and managed risk well and stored medication safely. They minimised the use of restrictive practices.
• 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 cared for in a mental health rehabilitation hospital and this was done in line with national guidance about best practice.
• The teams included or had access to the full range of specialists required to meet the needs of patients on the wards including occupational therapy and psychology.
• Managers ensured that staff received training, supervision, and appraisal.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Carers confirmed they were actively involved in care decisions.
• Patients were positive about the care they received from staff and felt actively involved in care decisions. All the patients interviewed felt safe. Carers were also highly satisfied with the service.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. There were records of patients being discharge back into the community.
• The service worked to a recognised model of mental health rehabilitation. Staff morale was high. The hospital was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Despite most records being electronic staff had continued to create large paper records which were not always as up to date as the electronic record. This meant that staff did not always have access to the most up to date information about patients.

Updated 19 February 2024

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. The hospital environment was safe and clean. The hospital 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 cared for in a mental health rehabilitation ward 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 staff worked well together as a multidisciplinary team and with those outside the hospital who would have a role in providing aftercare, for example local community mental health teams.
• 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.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Despite most records being electronic staff had continued to create large paper records which were not always as up to date as the electronic record. This meant that staff did not always have access to the most up to date information about patients.