You are here

This service was previously registered at a different address - see old profile

Reports


Inspection carried out on 7th and 8th October 2019

During a routine inspection

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 carried out on 18 July 2017

During a routine inspection

We rated Monet Lodge as good because:

  • The ward was clean, tidy and well maintained. The clinic room was fully equipped and emergency equipment was checked regularly. Staff were aware of how to report incidents and all staff had access to the online reporting system. There were single sex ensuite bedrooms and a separate female lounge in accordance with same sex guidance. There were good systems in place for ordering, dispensing and storage of medications. Staff were aware of their responsibilities under duty of candour.
  • There was good evidence that National Institute for Health and Care Excellence guidance was being followed in relation to prescribing and monitoring of medication and non-pharmacological treatments for dementia. Staff completed a physical health check on admission and these were regularly reviewed throughout the patients stay at Monet Lodge. Mandatory training was at 86% and staff took part in clinical audits including medications, care records and mental health act documentation. Staff had a good understanding of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. The service adhered to the Mental Health Act and the revised Mental Health Act Code of Practice. Mental Health Act documentation was complete and correct.
  • Staff engaged positively with patients and their carers. All interactions we observed were respectful, kind and maintained the dignity of the patient. Carers and relatives told us that the staff were friendly and approachable and always took the time to speak to them and involve them in their loved ones care.
  • There was a full range of rooms to support the care and treatment of patients with complex needs. There was a good variety of activities available to patients seven days a week. Information was available in easy read format and in other languages if required. There was access to spiritual support and the chef was able to provide food for any specialist needs such as vegetarian, vegan, halal and kosher. Patients had access to an independent mental health advocate who visited the hospital and attended care programme approach meetings if patients wanted them to.
  • Staff were aware of the organisations vision and values and these underpinned all the work they did. These were incorporated into staff meetings, supervision and the key performance indicators for staff. The staff felt supported by the manager and the clinical lead and felt that their suggestions about the service were listened to.

However,

  • On the day of our inspection, the clinic room floor and worktops were dirty and the plastic suction tip on the suction machine was uncovered. On our return to the hospital this had been rectified and the room was added to the cleaners schedule for a daily clean.
  • The ligature knife was locked in a drawer that not all staff had a key to.
  • The clinic room temperatures were found to be over 25 degrees Celsius on a regular basis.

  • Due to the amount of care plans some patients had (up to twenty) we found that some care plans were generic and not person centred. We found one example where the patient was referred to as “he” when the patient was a “she” and one with another patients name in.

Inspection carried out on 8 and 9 September 2015

During a routine inspection

We rated Monet Lodge as good because:

  • the design and layout of the environment reflected best practice in dementia care, all areas were clean and clutter free, and ligature and falls risks were adequately mitigated
  • the service had a stable staff team and an appropriate skill mix, which helped ensure continuity of care for patients’ physical and mental health needs
  • staff did not use prone (face-down) restraint or rapid tranquillisation techniques but did occasionally use the ‘holding’ technique (a low level of restraint), and only after de-escalation (calming down) techniques had failed
  • medicines management practice, including storage, dispensation and administration was mostly in line with the relevant guidelines
  • patients’ care records were thorough, up-to-date and personalised, and contained a range of assessments and care plans associated with their physical and mental health needs
  • patients received co-ordinated and all-round care and treatment from the multidisciplinary team, with each specialism contributing their specific skills and expertise
  • staff received timely and meaningful supervision and appraisal, and managers encouraged their personal and professional development
  • staff had a good understanding of the Mental Health Act (MHA), the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS), the service adhered to the MHA and the revised MHA Code of Practice, and MHA documentation was in place and up-to-date
  • there was a strong person-centred culture within the service and staff knew the patients and their relatives well
  • we observed caring and respectful interactions between staff, patients and relatives
  • relatives gave very positive feedback about Monet Lodge and were particularly impressed by the highly-motivated and caring staff, and the excellent care they provided
  • the unit contained a full range of facilities and equipment to support treatment and care, and patients had access to a wide range of dementia-friendly activities tailored to their needs
  • staff, including specialists, assessed patients’ dietary needs and informed the unit’s cook of any specific requirements
  • the service had a clear governance structure, with effective systems and processes for overseeing all aspects of care including regular management meetings, a programme of audits and access to a service improvement team
  • there was good morale among staff: they experienced job satisfaction, they felt valued and supported by colleagues and managers, and they shared the provider’s vision and values for their service.

However:

  • staff were not up-to-date with all their mandatory training
  • medicines were not always ordered promptly, medicine errors were not always reported appropriately, and when nurses retrospectively corrected gaps found in medicine charts, this increased the risk of errors
  • new ‘capacity to consent to treatment’ assessments were required for all patients because Monet Lodge had a new responsible clinician, but these had not yet started
  • in one patient’s care records, handwritten medical notes indicated that relatives had given consent for vaccinations on two occasions, with no reference to the MCA and the best interests framework (legislation that describes what to do when a person lacks the capacity to make a specific decision)
  • although records contained information about patients’ health-related dietary needs, we did not see any recorded information about their food preferences.