During an assessment of Acute wards for adults of working age and psychiatric intensive care units
The service provided safe care. The ward environments were pleasant, safe and clean. The wards had enough staff and ward teams had access to the full range of specialists to meet the needs of patients. Staff minimised the use of restrictive practices and followed good practice with respect to safeguarding. Staff completed thorough risk assessments of wards and individualised risk assessments with patients and updated these regularly and/ or when risk presentation changed. Managers ensured that staff received training, supervision and appraisal and had developed strategies to boost staff wellbeing and recognise staff achievements. Feedback from patients and carers about the service was mostly positive. Most patients told us they felt safe, and that staff were caring and treated them with kindness and respect.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
The service admitted patients under the Mental Health Act 1983. At the time of the inspection, 23 patients were detained for assessment and/or treatment and 9 patients had been admitted on a voluntary basis.
Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice. Mental Health Act Code of Practice training was mandatory for staff and the compliance rate was 90.6% for permanent staff and 100% for bank staff.
Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from the Mental Health Act administrator based at the hospital and a regional MH act administrator.
The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.
Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time. Seven out of 8 patients that we spoke with said they had their rights read to them and 1 patient couldn’t remember.
Staff made sure patients could take section 17 leave (permission to leave the hospital) when this was agreed with the responsible clinician.
Mental Capacity Act
Staff received and kept up to date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory for staff and the compliance rate was 93.2% for permanent staff and 100% for bank staff.
Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff completed an assessment of each patient’s capacity to consent to admission and treatment on admission. Further assessments took place during reviews by the multidisciplinary team. We looked at 5 patient care records and could see there was evidence of assessment for mental capacity in all the records we looked at.
We saw evidence of a capacity assessment which had been completed with a patient who had type 1 diabetes but was not following dietary advice. The patient was deemed to have capacity and to be able to make unwise decisions, however this would remain under regular review and further capacity assessments/best interest decision meetings would be undertaken as needed.