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Inspection Summary


Overall summary & rating

Good

Updated 4 December 2019

We rated Monet Lodge as good overall because:

  • The service provided safe care. The ward environment was safe and clean. The ward 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 and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward team 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 ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • 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. Each patient had a document called “all about me”. This document contained lots of information about the patient and this information was gained in collaboration with the patient and carers
  • We saw memory boxes at the door of each bedroom which contained pictures of family, friends and pets, covers from favourite music and mementos from holidays.
  • The hospital manager had worked hard to forge relationships with local services to help maintain the hospital gardens. They had worked with different volunteer services who came in and painted murals on the garden fences, so the patients could enjoy these.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However,

  • The sensor system which was meant to alert staff to patient safety issues was sounding on a regular basis throughout the day. This was disturbing for the patients and resulted in patients becoming more agitated. There was no way to stop this function other than to turn the whole system off.
  • Two members of staff shared the activity coordinator role but one of them was on maternity leave and the post had not been covered. This meant that due to the hospital being busy at the time of our inspection activities did not always occur if the activity staff member was not on shift.
  • The lounge area was large and could be very noisy at times. Most patients spent their day in the lounge and due to the noise level some patients became agitated and disturbed by this and would benefit from a quieter space. There was a concertina door that could be used to section off the lounge. This was not being used at the time of our inspection. However, it would have made the environment less stimulating for patients.
Inspection areas

Safe

Good

Updated 4 December 2019

We rated safe as good because:

  • The hospital was safe, clean, well equipped, well furnished, well maintained and fit for purpose of delivering care to older people with dementia.

  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm

  • Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • Staff had easy access to clinical information and it was easy for them to maintain clinical records.

  • 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.

  • The ward 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.

    However,

  • The sensor system which was meant to alert staff to patient safety issues was sounding on a regular basis throughout the day. This was disturbing for the patients and resulted in patients becoming more agitated. There was no way to stop this function other than to turn the whole system off.

Effective

Good

Updated 4 December 2019

  • 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.

  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. We found that medication was prescribed in line with guidance from the National Institute for Health and Care Excellence, namely Dementia: assessment, management and support for people living with dementia and their carers [NG97].They ensured that patients had good access to physical healthcare and supported patients to live healthier lives.

  • The ward team had access to the full range of specialists required to meet the needs of patients on the ward. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.

  • 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 ward team had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.

  • 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 4 December 2019

  • 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 carers in patient care plans and ensured that patients had easy access to independent advocates.

  • Staff informed and involved families and carers appropriately.

  • The hospital manager had worked hard to forge relationships with local services to help maintain the hospital gardens. They had worked with different volunteer services who came in and painted murals on the garden fences, so the patients could enjoy these.

    However,

  • Two members of staff shared the activity coordinator role but one of them was on maternity leave and the post had not been covered. This meant that due to the hospital being busy at the time of our inspection activities did not always occur if the activity staff member was not on shift.

Responsive

Good

Updated 4 December 2019

  • Staff managed beds well. This meant that a bed was available when needed and that patients were not moved. Discharge was rarely delayed for other than clinical reasons.

  • The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Each patient had their own bedroom and could keep their personal belongings safe. We saw memory boxes at the door of each bedroom which contained pictures of family, friends and pets, covers from favourite music and mementos from holidays. There were quiet areas for privacy.

  • The food was of a good quality and hot and cold drinks were available although due to the high levels of cognitive impairment of the patient group staff would make these.

  • The service met the needs of all patients who used the service – including those with a protected characteristic. Staff helped patients with communication, 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,

  • The lounge area was large and could be very noisy at times. There was a concertina door that could be used to section off the lounge. This was not being used at the time of our inspection. However, it would have made the environment less stimulating for patients.

Well-led

Good

Updated 4 December 2019

  • 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 were applied in the work of their team.

  • Staff felt respected, supported and valued.

  • Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.

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

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

Checks on specific services

Wards for older people with mental health problems

Good

Updated 4 December 2019

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