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Inspection Summary


Overall summary & rating

Good

Updated 23 July 2018

We rated Lea Court as good because:

  • The hospital complied with the Department of Health guidance on same sex accommodation.
  • There was enough staff to provide recovery-based care and treatment to patients.
  • Patients’ risk assessments were well completed and reviewed.
  • There were minimal significant incidents but when incidents did occur, staff learnt lessons.
  • Staff carried out regular physical health checks with patients.
  • Patient recovery plans were well completed and personalised.
  • There was good multidisciplinary working with thorough occupational therapy assessment and input.
  • Staff were receiving specialist clinical skills training to provide more effective care and treatment to patients with a personality disorder.
  • Staff were trained in, and adhering to, the Mental Health Act and Mental Capacity Act.
  • Comments from patients on the standards of care and treatment were positive.
  • Patients were involved in identifying their own goals to aid meaningful recovery and developing their care plans.
  • There were regular weekly patient community meetings occurring for patients to discuss day to day issues.
  • Staff had regular contact with community mental health team professionals and the hospital had links with the wider community.
  • There were no patient complaints and managers had put in systems so that if informal complaints were made they were managed well.
  • Staff morale was good and there was good local leadership.
  • Governance arrangement and checks in place were good.

However:

  • There was a domestic sink in the clinic room with plug and overflow which did not meet good infection control measures. The provider was taking action to address this.
  • Following a recent incident, managers at Lea Court had not been able to fully clarify the pathways into acute mental health inpatient and psychiatric intensive care for deteriorating patients with local partners.
  • There was no designated on-site psychologist but patients had access to psychological services.

  • Managers were working to improve formal supervision uptake rates.

  • Although staff were regularly informing detained patients of their rights, we found a small number of patients’ files where staff had not revisited patients’ rights at particular intervals such as, in one case, when a patient’s detention was renewed.
  • While overall adherence to the Mental Capacity Act was good; we did see in one case, nursing staff had applied for a standard Deprivation of Liberty Safeguards application and were still awaiting a decision but had not applied for an urgent authorisation alongside this. This was rectified at the earliest opportunity.
  • Written minutes of community meetings did not always clearly record what action was needed or what action had been taken to show that patients’ concerns had been fully addressed.
Inspection areas

Safe

Good

Updated 23 July 2018

We rated safe as good because:

  • The hospital complied with the Department of Health guidance on same sex accommodation.
  • There were enough staff to ensure the safety of patients at all times.
  • Staff carried out ongoing risk assessments on patients.
  • Patients were not subject to blanket restrictive practices and each patient had a very detailed plan in place to ensure that any restrictions were individualised, were kept to a minimum and regularly reviewed.
  • Managers had made improvements to ensure that there were enough staff safety alarms available.
  • There were a range of well-completed health and safety and medication audits in place.
  • Staff understood safeguarding procedures and took action to safeguard vulnerable patients.
  • The hospital had minimal incidents but when these occurred they told us about them and took appropriate action to address them and learnt lessons.

However:

  • There was a domestic sink in the clinic room with plug and overflow which did not meet good infection control measures. The provider took action to address this.

Effective

Good

Updated 23 July 2018

We rated effective as good because:

  • The hospital was recovery focused.
  • Staff and patients worked together to complete care and support plans from a recognised recovery based assessment tool (the mental health recovery star tool).
  • Patients received medical and clinical interventions to minimise symptoms of their mental health through both medication and psychosocial interventions.
  • Patients received input from a multidisciplinary team which included a consultant psychiatrist, visiting GP, nurses trained in psychosocial approaches and an occupational therapist.
  • Staff were receiving specialist clinical skills training to provide effective care and treatment to patients with a personality disorder.
  • Staff provided individualised support to patients over daily tasks such as budgeting, planning and shopping for meals and cooking.
  • Patients received support to ensure they received appropriate physical health care.
  • There were good systems in place to support adherence to the Mental Health Act (MHA).
  • Where mental capacity assessments were carried out, these were decision specific and followed the principles and stages set out in the Mental Capacity Act.

However:

  • There was no designated on-site psychologist but patients had access to psychological services.
  • Managers were working to improve formal supervision uptake rates.
  • Although staff were regularly informing detained patients of their rights, we found a small number of patients’ files where staff had not revisited patients’ rights at particular intervals such as, in one case, when a patient’s detention was renewed.
  • While overall adherence to the Mental Capacity Act was good; we did see in one case, nursing staff had applied for a standard Deprivation of Liberty Safeguards application and were still awaiting a decision but had not applied for an urgent authorisation alongside this. This was rectified at the earliest opportunity.

Caring

Good

Updated 23 July 2018

We rated caring as good because:

  • Patients were positive about the staff in the hospital stating they provided high quality care and support.
  • We observed staff providing support to patients in a calm and caring manner.
  • Patients were seen as active partners and were encouraged to be involved in decisions that affected them.
  • Patients were involved in identifying their recovery goals and developing their care plans.
  • Patients were encouraged to be involved in the running of the hospital.
  • Patients had access to independent advocacy input.

However:

  • Written minutes of community meetings did not always clearly record what action was needed or what action had been taken to show that patients’ concerns had been fully addressed.

Responsive

Good

Updated 23 July 2018

We rated responsive as good because:

  • The hospital started planning for patient discharge from when patients were first admitted.
  • Patients being prepared for discharge were able to choose which hospital support work staff would follow with them to provide ongoing community support, where possible.
  • The hospital had a homely feel and there were a range of rooms and facilities for patients including an outdoor gym and bikes to loan from the hospital.
  • There had been no formal complaints at Lea Court for the last 15 months.

  • Managers had made improvements to ensure that there was a system for recording informal concerns on the electronic database.

However:

  • Following a recent incident, managers at Lea Court had not been able to fully clarify the pathways into acute mental health inpatient and psychiatric intensive care for deteriorating patients with local partners.

Well-led

Good

Updated 23 July 2018

We rated well-led as good because:

  • Staff morale was good.
  • There was good local leadership and staff felt well supported by an experienced and committed registered manager who was very patient-centred.
  • Manager and senior nurses felt well supported with ongoing support from staff at the regional office.
  • Staff were focused on patients’ recovery.
  • Governance arrangement and audit checks in place were good.
  • There was good adherence to requirements relating to staffing, training and mental health legal requirements.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 23 July 2018