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Jeesal Cawston Park Requires improvement

Reports


Inspection carried out on 27 and 28 August 2020

During a routine inspection

Jeesal Cawston Park provides a range of assessment, treatment and rehabilitation services for adults with learning disabilities and autistic spectrum disorder.

We rated Jeesal Cawston Park as requires improvement because:

  • At this inspection, the inspection team found further incidents where patients were placed at risk of harm due to observations not being completed correctly. Despite the senior management team putting extra measures in place to address concerns raised at the last inspection, the issue had not been resolved and patients were still being put at risk. At the last three inspection concerns were raised that staff did not correctly carry out supportive observations.

  • Staff who witnessed colleagues sleeping on duty did not challenge this poor practice and accepted this behaviour. We reviewed seven pieces of randomly selected CCTV footage and found that on five of the occasions a member of staff was asleep when they were meant to be carrying out their duties. When some staff commenced their enhanced observation duties, we saw that they had brought with them a cushion or pillow and made themselves comfortable on the chairs before falling asleep. We saw evidence of staff moving chairs, or sitting in unusual places such as a kitchen worktop, which positioned them out of sight of the CCTV cameras. This demonstrated there was intent behind their actions and evidence of a culture which covered up these practices amongst night staff. This could be seen as indicative of a closed culture. When staff were sleeping, they would not be alert and able to respond quickly if immediate action was needed to keep a patient or a colleague safe. Therefore, this posed a significant risk to the safety of patients.

  • The leadership team had not effectively addressed the issues outlined above despite being aware of these for over ten months. Managers had initially attributed the issue of staff sleeping to the use of agency staff; indicating it was agency staff who engaged in this practice. However, seven out of the eight staff members noted on the CCTV footage were permanent employees at the hospital.

  • Staff did not sufficiently encourage patients to maintain a healthy lifestyle, for example to manage their weight by eating a healthy diet and do sufficient exercise. The 2018 Learning Disabilities Mortality Review found that poor quality healthcare causes health inequalities and avoidable deaths and people with a learning disability have worse physical and mental health than people without a learning disability. Therefore, if patients are not supported to maintain a healthy lifestyle this could have a disproportionate impact on their physical health. We were not assured that staff were working closely with the patients to agree and implement healthy living plans or that it was identified as a need in a timely manner, for example, before the patient had gained a significant amount of weight. This had seriously impacted on patients with co-morbid physical health conditions. Both the GP and patients’ relatives had voiced concerns about this.

  • Staff had not taken all actions necessary to reduce the spread of infection. At the time of the inspection, there was a heightened risk of infection due to the Covid-19 pandemic. During the inspection, we found that systems and processes were not effective in identifying and reducing all infection control risks, for example, broken equipment and a lack of cleaning in some areas

However:

  • The service now had enough nursing and support staff to ensure that it could meet patients care and treatment needs.
  • All patients had a care plan which was accessible and in an easy-read format. This was an improvement since the last inspection.
  • During the inspection, we observed many kind and positive interactions between staff and patients.

Inspection carried out on 27 May 2020

During an inspection looking at part of the service

Jeesal Cawston Park provides a range of assessment, treatment and rehabilitation services for adults with learning disabilities and autistic spectrum disorder.

The Care Quality Commission is currently undertaking enforcement action at Jeesal Cawston Park to cancel the provider’s registration and prevent the provider from operating the service. This is subject to ongoing review. The service was rated as inadequate and put into special measures following an inspection in June and July 2019. The service was re-inspected in November 2019 and February 2020, however insufficient improvements were made, and the hospital remained in special measures and a Notice of Decision was issued for closure subject to legal process.

This inspection was an unannounced, focused inspection in response to the provider notifying us of two incidents relating to patient safety. We looked at specific key lines of enquiry during this inspection relating to patient safety and the provider’s governance systems. It was not the purpose of the inspection to review the special measures status, which remains in place.

We found evidence to substantiate our concerns regarding patient safety as enhanced patient observations were not completed in line with the provider’s observation policy. Although we found managers had taken action to address these concerns, further improvements were required to prevent incidents from continuing to occur.

We did not re-rate this service at this inspection. The rating of inadequate from the inspection in February 2020 remains unchanged.

We found the following areas required improvement:

  • Enhanced patient observations were still not completed in line with the provider’s observation policy, despite the provider implementing strategies to address this concern. We saw evidence from a recent incident in which a staff member had fallen asleep whilst completing patient observations. Evidence also suggested that patients who should have been cared for on one to one observations were cared for on intermittent observations, which was not based on the patients risk level or behaviour. One to one observations are designed to support patients who are deemed as a higher risk of harm to themselves or others.
  • We were not assured that all serious incidents were investigated, reviewed and that lessons learned were shared with staff. The provider did not have an established forum to discuss serious incidents and the Registered Manager and Head of Communications and Quality were unable to tell us who had oversight of the quality of patient care. We were informed that the Head of Communications and Quality focused on Communications. Reviewing and learning from incidents was also a concern at our previous two inspections in February 2020 and November 2019.
  • The governance systems in place were not sufficiently embedded to provide adequate oversight and monitoring of the quality and safety of the service. The provider had worked to make improvements to the process of audits however many scheduled audits were not completed. Governance and audit processes were highlighted as areas of concern with our last three inspections of the service in June and July 2019, November 2019 and February 2020. 
  • Staff did not always manage risk to patients and themselves well as patient risk assessments and treatment and support plans were not always reviewed following incidents or within appropriate timescales. Therefore, we were not always assured that staff were aware of risks for individual patients.
  • Staff did not notify CQC of all reportable safeguarding incidents in a timely manner. We highlighted this to managers at the time of our inspection who informed us they would correct their CQC reporting process.
  • The provider could not provide assurance that they could deploy enough registered nurses and support staff with the right skills and competence to meet the needs of the people using the service and to manage patient risks. We were not assured that staffing rotas were accurate, and we saw evidence of staff shortages in incident logs and when speaking with carers. Staff shortages were a concern at our previous inspection in February 2020.

However:

  • Staff completed comprehensive initial risk assessments for patients in which they identified triggers and strategies to support patients. Initial treatment and support plans also highlighted patient risks.
  • The overall number of reported incidents at the hospital had decreased, which managers believed was due to an increase in patient activities and not just because of a reduced number of patients at the service.
  • Staff we spoke with felt that the Registered Manager had an open and transparent leadership style and had improved communication within the service. As a result, staff felt more involved and comfortable to raise concerns.

Inspection carried out on 11 and 12 February 2020

During a routine inspection

Jeesal Cawston Park provides a range of assessment, treatment and rehabilitation services for adults with learning disabilities and autistic spectrum disorder.

We rated Jeesal Cawston Park as inadequate because:

  • During this inspection we found further significant concerns. The provider had also not made all the improvements it was required to make following our previous inspections. We began enforcement proceedings against the provider and issued a Notice of Proposal to cancel the hospital’s registration as a provider.

  • Staff did not manage risks to patients well. In the month prior to the inspection, and the two weeks following inspection, the service continued to report incidents where patients were harmed, or exposed to risk of harm, due to observations not being completed correctly. The service had not addressed the risk of fire. We saw fire risk assessments for all areas of the hospital which indicated there was a moderate to substantial risk to life from fire. We requested evidence of any actions that had been taken to address these risks, but managers were unable to provide these.
  • The service did not have enough nursing and support staff to ensure that it could meet patients’ care and treatment needs. Staff described difficulties in meeting the demands of their roles because of staff shortages. Staff did not provide enough activities for patients. There was a lack of activities particularly at weekends and evenings, including for patients in long-term segregation.

  • Staff did not use processes to safely prescribe, administer, record and store medicines. Staff recorded as required medicines (PRN) reviews inconsistently. Staff had not effectively monitored patients on high dose anti-psychotic therapy and had not clearly documented the rationale for giving a patient in long term segregation the maximum dose of anti-psychotic medicine.

  • Staff did not always respect patient’s privacy and dignity. Staff left patients in long term segregation in undignified situations.

  • The provider had not ensured that all staff were trained in Makaton or Signalong to communicate with patients whose main form of communication was Makaton.

  • There was a lack of effective leadership and governance. There had not been a consistent senior leadership team in place at the hospital since July 2019. Staff told us they were not always clear about their roles and accountabilities, and changes in leadership made it difficult to be confident about processes and procedures and their responsibilities in relation to these. Managers did not have effective oversight of staff management of patient risk and the service did not have effective systems and processes, such as regular audits of the service provided, to assess, monitor and improve the quality and safety of the patients at the hospital and to manage performance effectively. At the time of inspection, a new Chief Operating Officer (COO) had been appointed and had been in post for four weeks. We spoke with the COO during the inspection and they demonstrated a good understanding of the challenges that the service faced and had begun to make a plan to manage them. However, it was too early to say whether these changes would be effective and sustainable.

However:

  • Most patients told us that staff were kind and caring and we observed some positive interactions between staff and patients.

  • The service had improved discharge planning since the last inspection.
  • The service had created two new sensory rooms for patients and provided training for 22 members of staff to enable them to support patients effectively to use the sensory rooms and sensory equipment.

Inspection carried out on 13 - 14 November 2019

During an inspection looking at part of the service

The Care Quality Commission inspected

Jeesal

Cawston

Park Hospital in June and July 2019. Following that inspection, we rated the service as inadequate.

Due to our concerns, we issued the hospital with a warning notice

for a breach of regu

lation 17 of the Health and Social

Care Act

(2008)

and placed it into special measures.

This inspection was an unannounced, focussed inspection to follow up on the warning notice and to assess whether the provider had made the required improvements.

During the inspection period, w

e found significant concerns that required

urgent

action. We

have taken

further

enforcement

action

against

the provider

to require

that

,

w

ith immediate effect, the Registered Provider must not admit any patients to any ward at

Jeesal

Cawston

Park hospital without prior written agreement of the Care Quality Commission

.

We found some areas of improvement

. However,

we found that

further

improvements were

required,

or

it was too early to judge whether

the

measures the provider had put in place

had

an

impact or

were sustainable.

We did not

re-

rate

this service at this inspection.

We found the following areas

required improvement

:

  • There had not been a consistent senior leadership team in place since July 2019. Whilst some members of the leadership team had been with the organisation for some time, there was evidence of changes in roles which affected the stability of the leadership team. The registered manager left in July 2019 and an interim appointment was made to cover this vacancy who unfortunately was on long term sick.  This meant that other senior managers had to fulfil the role.

    There had been a restructure of the quality improvement team.

    We were not assured that

    there was the stable, robust leadership

    in place

    in order to

    embed and sustain

    the

    quality improvement

    s necessary to ensure effective and safe patient care.

  • The provider

    did

    not demonstrate

    that governance systems were sufficiently embedded to

    be assured of the impact and sustainability of these systems.

    For

    example,

    w

    e were not

    assured that

    the quality of clinical observations was consistent and

    sustainable

    due to

    new staff not receiving observation training from March to September 2019

    .

    Managers had not prioritised

    the oversight of

    patient observations

    despite a high number of safeguarding incidents

    directly related to this concern

    in the six months prior to this inspection.

    Managers had

    not

    implemented recommendations made by an external nurse consultant relating to patients swallowing foreign objects as a matter of priority

    .

  • Recruitment and retention of qualified nurses remained challenging and staff we spoke to described difficulties in meeting the demands of their roles. We spoke to 16 members of staff. Three members of staff told us that the wards could be short-staffed and sometimes staff were unable to escort patients on trips out of the hospital because of this. One member of staff told us that because of a high number of incidents the previous day, general observations had not been completed as per the observation and engagement policy. This could have an impact on patient safety.

  • Staff

    did not have

    a co-ordinated approach

    to

    the completion of audits or the implementation of quality improvement work.

    We spoke to senior managers and four members of staff who were involved in quality improvements and audit

    and we observed staff working on separate projects without management oversight or actions being taken.

    For example, one person working on quality improvement had reviewed incidents relating to patients swallowing objects.

    However, managers had not discussed the review, drawn up an action plan or put into place any of the recommendations made.

    The provider had reported further incidents of patients swallowing objects since the time of the review.

    Managers were not acting on concerns and reviews with

    enough

    co-ordination and urgency which

    h

    a

    d

    a

    n impact on improving patient safety.

  • Staff did not ensure care and treatment records contained information on the patients’ capacity. We found no individualised assessments of capacity for specific decisions within patient records

    except for

    the use of medication.

  • During the inspection we found an infection control issue on the Manor. We also found poorly written lessons learnt bulletins. Managers acknowledged our findings at the time of inspection. The provider’s internal audits and governance processes had not identified these concerns.

    There were i

    neffective systems in place to assess and monitor the quality of care

    which

    was a concern at the last inspection.

However

:

  • Staff ensured that

    patients

    cared for

    within long term segregation w

    ere nursed in accordance with Mental Health Act Code of Practice guidelines. Staff

    completed

    daily, weekly, monthly and quarterly

    reviews

    and we did not find any gaps in recording

    in the

    two

    weeks prior to the inspection

    .

  • The provider had improved discharge plannin

    g

    .

    Managers had

    reviewed the care planning structure to include a specific ‘working towards discharge’ care plan

    . We looked at

    six

    care plans and found that

    five out of six

    included a discharge plan

    with evidence of patient involvement.

  • Staff had made regular checks of emergency equipment and all signatures were in place.

  • Seclusion rooms met the standards

    required in the Mental Health Act Code of Practice and we saw evidence that staff were completing regular daily and weekly checks.

Inspection carried out on 20 - 21 June, 5 and 16 July 2019

During an inspection looking at part of the service

We rated Jeesal Cawston Park as inadequate because:

  • The hospital was not working to the model of an assessment and treatment unit and therefore its operation was not in line with the expectations of the Transforming Care Programme. The service was not proactive in enabling patients to leave hospital and return to life in the community. Some patients who had been resident at the hospital for some years had no discharge plan.
  • The provider had not ensured there were sufficient staff with the appropriate skills and training to deliver safe and effective care and treatment to patients. A high proportion of staff were unqualified support workers and, because of a high number of vacant posts, a substantial proportion of shifts were filled by bank or agency staff. Managers had not mitigated the risk this posed by ensuring that all staff had the training essential to provide high quality care to patients with complex needs in specialist setting. Also, the provider had not ensured there were sufficient staff on duty to complete patient observations in accordance with their policy.
  • Staff did not always ensure that patients nursed within long term segregation were nursed in accordance with the Mental Health Act Code of Practice guidelines.
  • Staff did not consistently complete physical observations of patients following restraint.
  • Staff carried out weekly emergency bag checks but there was no assurance or system in place that the emergency bag would be checked after each use or between these times. Clinic rooms were not all fully equipped. Staff had not accurately checked the emergency equipment. We found no cleaning records in any of the clinic rooms or a clinic room audit in one of the clinic rooms.
  • The service had not considered and responded to the needs of patients with autism in the ward environment. The service did not have any sensory rooms for patients and sensory equipment was minimal and not readily available for patient use.
  • Staff did not ensure care and treatment records contained information on the patients’ mental capacity. We found no individualised assessments of capacity for specific decisions within patient records with the exception of the use of medication.
  • Managers were not proactive in identifying and responding to issues within the service. Managers responded to issues when identified by external stakeholders and then did not do so promptly. Managers were not consistently responsive to patient needs. Managers did not have a good understanding of the service they managed.
  • The provider did not have an effective audit process to provide assurance or review the quality of the care provided at this hospital. There were poor governance arrangements in place to review audit processes. External stakeholders found issues that were not identified by the provider’s internal or external audits.

However:

  • Managers requested bank and agency staff who were familiar with the service. Managers gave each new member of staff a full induction to the service before they started work, including bank and agency staff. The ward manager could adjust staffing levels according to the needs of the patients.
  • All patients had their physical health reviewed regularly during their time on the ward. Staff supported patients with their physical health and encouraged them to live healthier lives. Staff made sure that patients had access to physical healthcare, including specialists as required.
  • The ward complied with guidance on the elimination of mixed sex accommodation. Each patient had their own bedroom with an en-suite bathroom, which they could personalise. The service had quiet areas and a room where patients could meet with visitors in private. Each ward had an outside space that patients could access easily.
  • Patients could make their own hot drinks and snacks and were not dependent on staff. The service offered a variety of good quality food and patients told us they liked it.
  • Managers were visible in the service and supported staff. Staff felt respected, supported and valued. Staff knew how to use the whistleblowing process and felt they could raise concerns without fear of victimisation.

Inspection carried out on 5 – 6 February 2019

During a routine inspection

We rated Jeesal Cawston Park as requires improvement because:

Staff did not ensure that patients in seclusion were having the required medical and nursing reviews to meet the standards outlined in the Mental Health Act (1993) Code of Practice (2008).

Staff did not ensure that the recording of seclusion was complete and accurate. Managers did not have sufficient oversight of seclusion and restraint recording, despite seclusion recording being identified at a previous focused inspection and in the hospital’s own internal audit.

The seclusion room did not meet all the required standards of the Mental Health Act (1993) Code of Practice (2008).

Staff did not consistently and accurately fully record incidents involving restraint and the management of violence and aggression.Staff did not ensure that all patients in long term segregation were reviewed by an approved clinician every 24 hours and that all paperwork relating to long term seclusion was in place.

Staff did not ensure consistent recording of Section 17 leave for patients including risk assessment, clothing notes and details of patient engagement and behaviour whilst on leave.

However:

Staff knew the patients well and we observed good interactions across the hospital, with staff supporting and engaging with patients in a positive manner. Patients we spoke with told us they were happy at the hospital and the staff cared for them well.

There was a wide range of activities available for patients. Activity staff were enthusiastic about their role and told us that activities were person-centred and planned for patients on an individual basis, considering their preferences and interests.

Patients had comprehensive care plans that were holistic, patient focused and included a pen picture, observation and engagement plans, and goals for improving quality of life.

We observed a positive culture and good staff morale during the inspection. Staff we spoke with told us there was good teamwork and they felt respected and supported by managers and colleagues.

Inspection carried out on 12 and 13 November 2018

During a routine inspection

Ratings are not given for this type of inspection.

We found the following areas for improvement:

  • We saw environmental issues that prevented the provider from offering safe services. The seclusion room did not meet the standards of the Mental Health Act Code of Practice. The two-way communication system was not fully working in the seclusion room and the layout of the seclusion room did not enable clear observation of the patient. Ligature risks on The Lodge and courtyard had not been identified within the ligature risk assessment. Where risks had been identified, actions to mitigate the risk posed to patients were not carried out.
  • Staff did not always record information thoroughly. Nine seclusion records were incomplete and staff did not record patient observations within the seclusion records. Staff did not always record episodes of restraint within patient notes. Patients' risk assessments were not always updated following incidents.
  • The provider did not deploy sufficient numbers of staff to safely maintain patient observation levels.
  • Managers did not accurately identify incidents and learning from incidents was not routinely shared and discussed with staff.
  • Medication was not stored safely or securely.
  • Physical healthcare was not consistently recorded and physical observations following patient restraint did not always take place.

Inspection carried out on 12 -13 December 2017

During a routine inspection

We rated Jeesal Cawston Park as good because:

  • Staff throughout the hospital knew the patients, there was evidence across the site of good interactions, positive support and engagement Staff knew patient’s likes and dislikes. There was a full range of rooms available for activities from exercise to education and therapies. The lodge patients had a separate kitchen where they engaged in supervised cooking activities. The hospital site also had a small farm. Patients gave feedback on their care and service in ward-based meetings, allowing patients to make suggestions around activities and food.
  • Psychological therapies were offered, as recommended by the National Institute for Health and Care Excellence. The range of interventions included post-traumatic stress disorder, anger and anxiety, bereavement, emotional and distressed behaviour. These were available for patients on a one to one basis, in groups and with family.
  • There was a physical healthcare lead nurse, who was involved in health promotion such as smoking cessation and infection control regarding personal hygiene. The hospital had recently held a physical wellbeing day to promote healthy living.
  • There were three new clinic rooms including a GP room. Rooms and patient bedrooms were clean and well, maintained furnishings in place.
  • Managers ensured the correct levels of staff were on shift and, the hospital’s electronic system helped managers to effectively plan tasks ward by ward. Staff appraisals were up to date and Jeesal Cawston Park sponsored staff for further development and qualifications.

However:

  • There were environmental risks identified at the hospital, on one ward staff were not carrying personal alarms, on another ward we found two ligature points that were not identified on the ligature risk assessment.
  • We found one emergency medication was located in a different area of the hospital to the patient it was prescribed for.

Inspection carried out on 06 - 07 March 2017.

During a routine inspection

We rated Jeesal Cawston Park as requires improvement because:

  • Throughout the hospital, there were areas that needed some repair and had become dirty. The clinic room in the Manor had marks on the wall by the examination couch and dirty waste pipes by the sink. This could cause an infection control issue. Some patient bedrooms smelt of urine and had damp areas in the bathroom. Staff reported concerns that the hospital was not always clean and areas were in need of repair. Some family members said the hospital areas and patient bedrooms were dirty. These areas of concern had not been addressed by the hospital’s cleaning staff or the dedicated maintenance team.
  • On the Lodge, bedroom doors were untreated, scratched and scuffed. This could cause potential infection control issues. The providers’ infection control audit (dated November 2016) had identified this. However, no action had been taken to address the findings of this audit.
  • Staff rotas showed staff worked for long periods of a time without taking a break. We saw that these staff had requested to take their breaks at the end of the day to leave early. This meant there was not the correct level of staff on shift toward the end of that day.
  • We reviewed 22 patient positive behaviour support plans and could not easily identify the assessments which helped staff to create them. Most of these did not have any indication as to the frequency, duration and severity of distressing behaviours, which was something that could have helped staff and patients monitor change.
  • Physical health checks and physical health care entries were difficult to find on the provider’s electronic system. There was a lack of consistency between where in the records, and when, staff recorded any medical or physical care concerns.
  • The hospital did not use a recognised early warning system to monitor any deterioration in patient’s physical health care if needed.

However:

  • The person centred care guiding council group met weekly to discuss and improve person centred care across the hospital. Some outcomes of these meetings included findings from shadowing, a reduction in restrictive practices and developing MDT meetings to be more patient-centred. This group also aimed to have family representatives take part.
  • Patient activities were rarely cancelled due to short staffing, activities, section 17 leave were planned, and staffing levels made to meet the requirements. Where activities had been cancelled, alternative options were in place.
  • Meeting minutes showed managers had made changes following incidents. For example, changes were made to the environment of a patient’s living area, to help prevent injury.
  • The hospital had employed a transitional nurse who provided examples of how they supported admissions and discharges in a co-ordinated manner.
  • Patients personalised their bedrooms, patients said they felt their rooms were big enough. We saw patients had personal possessions in their room.
  • Staff knew patients’ individual needs, background and had a good understanding of their mental health, physical health and learning needs. Staff shared examples of how patients had progressed since being at the hospital
  • Staff involved patients and their family in assessments and care plans. Family members were invited to attend multidisciplinary meetings and reviews.
  • Seven family members said they had seen a vast improvement in their loved ones since their admission to this service. They said they felt their loved one was safe, had demonstrated improved behaviours and was happy there.

Inspection carried out on 10 January 2017.

During an inspection looking at part of the service

We did not rate Jeesal Cawston Park because this was a focused inspection:

  • Both lodges had blind spots where staff could not observe all areas. Staff mitigated risks to patients by updating patient risk assessments, carrying out one to one observations and escorting patients at all times. Managers reviewed these risks during monthly multidisciplinary meetings.
  • A pharmacist attended the lodges once a week to carry out medication audits, staff kept patient consent to treatment with patient medical records and created an individual patient passport detailing both physical and mental health care needs.
  • Staff knew how to report incidents, there was a clear system in place which alerted managers straight away to any incidents. Managers shared incident outcomes and lessons learnt in team meetings.
  • Staff developed easy read care plans and paperwork for patients. Staff involved patients with decisions and input in their care plan. There was a range of activities and treatments available for patients.
  • Multidisciplinary meetings took place every four weeks. These meetings were attended by doctors, psychology staff, nursing staff, patients and family members.
  • We observed staff interacting with patients in a positive respectful manner. We saw staff offering practical support to ensure individual patient needs were met. Staff knew each patient’s preferences and needs.
  • Managers invited family members to patient review meetings and collected feedback from patients and families about the care and treatment provided.

However:

  • One staff member carrying out one to one observations reported that they were not confident in carrying these out. They reported that the hospital was not following their own policy.
  • Care and treatment records did not include detailed descriptions of how staff were helping patients to address individual skills on a daily basis. For example, one patient had a goal of building relationships, but the actions required to do this were not specific.
  • One member of staff could not find care plans on the provider’s electronic records.
  • Staff did not record all outcomes and the length of each episode of patient’s individual section 17 leave, clearly on patient records.

Inspection carried out on 22 - 23 September 2015

During a routine inspection

We rated Jeesal Cawston Park as good because:

  • Staff demonstrated a caring attitude towards patients and had regular one to one time with them.
  • Staff were up to date with their mandatory training, and were provided with additional training if it enhanced their knowledge of a specific patient need.
  • Friends and family expressed satisfaction with the care and welfare of their loved ones whilst in the hospital.
  • The provider had good reporting systems in place when things went wrong, so these could be discussed and learned from.
  • Patients were allowed to personalise their bedrooms and were involved in choosing how to decorate their ward or unit.
  • There was a wide range of activities for patients to engage in.
  • Support workers were being supported to complete the National Care Certificate.

However:

  • Blanket restrictions for therapeutic reasons were in place that included access to hot drinks and times people could smoke. Risk was not always considered on an individual basis. Senior management said they would review these restrictive practices.
  • Staff did not clearly document evidence of patient involvement in their own care plan.

Inspection carried out on 16 January 2015

During an inspection in response to concerns

The service provided was safe. People told us they felt safe in the hospital. Staff engaged with people in a positive way and adopted a consistent and therapeutic approach.

Safeguarding issues were being appropriately reported. Staff were receiving their mandatory safeguarding training. The relevant records seen showed us that clinical risks were being managed safely by the provider.

The service was effective. Each person had an individual care record which included assessments of specific needs. Individualised care plans were in place. We found that individuals were having their rights protected under the 1983 Mental Health Act.

The service was caring. Most people told us that they felt involved in their own care and treatment. Staff interacted with people in a way which was positive and caring.

The service was responsive. Systems were in place to assess and manage any assessed risks for the people who used the service. People told us that they felt able to share any concerns with front line staff. We saw that there were a number of noticeboards on each unit to facilitate the provision of information to people.

The service was well led. Records were in place that demonstrated that the provider assessed and monitored the quality of their services.

You can see our judgements on the front page of this report.

Inspection carried out on 2 July 2014

During a routine inspection

The service provided was safe. People told us they felt safe in the hospital. Staff engaged with people in a positive way and adopted a consistent and therapeutic approach. Safeguarding issues were being appropriately reported. Staff were receiving their mandatory safeguarding training. The relevant records seen showed us that clinical risks were being managed safely by the provider.

The service was effective. Each person had an individual care record which included assessments of specific needs. Individualised care plans were in place. We saw monthly health of the nation outcome scale (HONOS) reviews documented in individual care records.

The service was caring. We found that individuals were having their rights protected under the 1983 Mental Health Act. Most people told us that they felt involved in their own care and treatment.

The service was responsive. Systems were in place to assess and manage any assessed risks for the people who used the service. People told us that they felt able to share any concerns with front line staff. We saw that there were a number of noticeboards on each unit to facilitate the provision of information to people.

The service was well led. Records were in place that demonstrated that the provider assessed and monitored the quality of their services. We noted that any required actions had been identified and subsequently addressed.

Inspection carried out on 1, 2 May 2013

During an inspection looking at part of the service

At our December 2012 inspection we found that the provider was non-compliant with this standard because the care and treatment provided to people was not always sufficiently individualised and did not take account of changes in their circumstances. The provider sent us an action plan that set out how they intended to make improvements to ensure that they achieved and maintained compliance with this standard. At this inspection we found that significant improvements had been made.

During our inspection we spoke briefly with patients and one family who were visiting a relative at The Grange. We also observed interactions between staff and patients and found them to be mutually respectful. Patients told us that staff supported them well and understood their needs. One visitor expressed concerns about how their relative�s physical health needs were being addressed and how their belongings were managed. We followed this up and found evidence that staff were supporting the individual appropriately.

Inspection carried out on 19 December 2012

During a routine inspection

We spoke with five out of the nine patients receiving treatment and support at The Grange. They said they were treated with dignity and respect in their daily contact with staff. Staff talked with them about their needs and how they wanted to be supported. Patients had access to an independent advocate to help them to make decisions and put their views forward.

We found that patients did not always understand restrictions placed upon them or their rights with regard to some of the practices in the hospital.

Three patients told us that they thought the treatment and support they received met their needs. However, we had concerns that staff were not always clear about risks to patients� health and safety.

Three patients said that the activities on offer did not really interest them. A new programme had been developed with the intention of giving patients more variety.

The parts of the hospital we saw were clean and hygienic. Staff had infection control training which was put into practice.

Patients said they thought there were enough staff on duty to support them. Staff absences were covered to ensure that staffing levels did not fall below the minimum set by the provider. Extra staff could be brought in if needed.

There were no formal complaints made about The Grange. However, we found a lack of clarity about the process for dealing with minor negative comments.