Edith Shaw Hospital

Updated 17 March 2022

When we inspected, the hospital had 10 patients admitted. Of these, seven were detained by the Mental Health Act 1983, two by Deprivation of Liberty Safeguards and one was informal. There was a CQC registered manager in post.

Edith Shaw Hospital is registered to provide the following regulated activities:

• Treatment of disease, disorder or injury

• Assessment or medical treatment, for person detained under the Mental Health Act (1983)

• Diagnostic and screening procedures

What people who use the service say

We spoke with three patients admitted to the service. One patient did not like the hospital and was derogatory about the staff, activities, and her care in general. Two other patients were more positive about the staff, their care and said they were happy at the hospital. However, all patients said that there were not enough activities.

Updated 17 March 2022

Edith Shaw Hospital is a 14 bed, female only, community based longer term high dependency rehabilitation unit. The service provides mental health rehabilitation services for women with complex mental health needs. Admissions are taken for women over 55 years of age. Patients may be informal or detained under the Mental Health Act 1983. The service is registered to provide long stay rehabilitation service for working age adults. However, the model of mental health rehabilitation does not meet recognised national guidance. We found the service provides nursing care for older females with mental health problems.

The service was placed in special measures following an inspection in January 2021 and was rated inadequate for safe and well led, with an overall inadequate rating. At the most recent inspection in August 2021, we issued the provider with a requirement to provide documentation and closed-circuit television recordings (CCTV) specific to incidents of physical redirection and where there was a record of a patient displaying behaviour that challenges between May 2021 and August 2021. We made this request because we identified a concern in relation to the way staff used physical interventions with patients. The requirement was issued under Section 64 of the Health and Social Care Act 2008.

Due to the seriousness of the concerns, we identified during the inspection and through our review of the provider’s Section 64 response, on 18 August 2021 we used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and imposed additional conditions on the provider’s registration. This included a condition to restrict the provider from admitting any new patients to Edith Shaw Hospital without the prior written agreement of the Care Quality Commission. This action also applied to the provider’s other location, John Munroe Hospital -Rudyard.

Our rating of this service improved. We rated it as requires improvement because:

• Staff assessed patient risk however, it was not easy to clarify when reading risk assessments and management plans what the current risks were and how to manage them. The plans were not clear and concise.
• Staff did not provide a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation hospital and in line with national guidance and best practice. Patients were not supported to lead an independent life. The service did not work to a recognised model of mental health rehabilitation or to its own statement of providing outcome focused rehabilitation.
• The hospital did not fully utilise the full range of specialists to ensure that patients received an appropriate rehabilitation plan with a view to improving their quality of life and activities of daily living.
• Care plans were repetitive at times and it was not easy to find relevant information quickly, however staff developed holistic, personalised care plans informed by a comprehensive assessment.
• Governance processes were in place but did not always identify areas for improvement for patient care, although governance had improved since our last inspection.

However:

• The service provided safe care. The hospital environment was safe and clean. The hospital had enough nurses and doctors. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Managers ensured that staff received training, supervision, and appraisal. Overall, staff worked well together as a multidisciplinary team and with those outside the hospital who would have a role in providing aftercare.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.

The conditions placed on the provider under Section 31 of the Health and Social Care Act 2008 at the previous inspection will remain in place. The provider cannot admit any new patients to Edith Shaw hospital without the prior written agreement of the Care Quality Commission.

You can read our findings from our all of our previous inspections by selecting the ‘all reports’ link for Edith Shaw Hospital on our website at www.cqc.org.uk.

Updated 17 March 2022