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John Munroe Hospital - Rudyard Inadequate

The provider of this service changed - see old profile

We are carrying out a review of quality at John Munroe Hospital - Rudyard. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 27 April 2021

John Munroe Hospital is part of the John Munroe Group and is an independent mental health hospital that provides care, treatment and rehabilitation for up to 57 adults, aged 18 or over, with long-term mental health needs. Edith Shaw Hospital is also part of the John Munroe Group and is located nearby in Leek, both hospitals share the same registered manager.

We undertook this unannounced, focused inspection based on concerning information received about poor infection prevention and control practice and the impact on patient and staff safety. We received several whistleblowing concerns and were informed in December 2020 that the provider had experienced a significant outbreak of COVID-19. In addition, we received death notifications which were all listed as COVID-19-related deaths. In response, a multi-agency improvement plan was implemented at the end of December 2020 to support the provider and gain assurance that actions were in place to mitigate risks to patients and staff. This involved the Care Quality Commission, Public Health England, NHS Staffordshire and Stoke-on-Trent Clinical Commissioning Groups and Health and Safety Executive.

We did not look at all key lines of enquiry during this inspection. However, the information we gathered, the significance of the concerns and clear impact on patients provided enough information to make a judgement about the quality of care and to re-rate the provider.

Due to the serious nature of the concerns, we immediately suspended John Munroe Hospital rating. The concerns related to infection prevention and control (IPC) measures and processes, including a lack of management oversight. Following the inspection, we served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider that we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within four days that described how it was addressing the IPC concerns. Their response provided enough assurance that they had acted to address immediate concerns and so we did not take forward urgent enforcement action.

We inspected two core service; working age adults in long stay rehabilitation mental health wards and wards for older people with mental health problems. The hospital mainly provides care to working age adults in long stay rehabilitation mental health wards, so although we inspected both services, we have reported on both core services in a single report.

Our rating of this location went down. We rated it as inadequate because:

  • The provider did not provide assurance all wards were safe, clean, well maintained and fit for purpose. Audits and checks were not enough to provide assurance staff were following good practice to prevent the spread of infection between healthcare workers and patients.
  • Staff did not always follow good practice in medicines management. Single use equipment was washed and reused. Oral medicines were not dated on opening and medicines were not being administered immediately after being dispensed.
  • Safeguarding alerts were not always made as required and the service did not always work well with other agencies. This had not improved since the most recent inspection in September 2020.
  • The service did not always manage patient safety incidents well. Staff told us they were not always supported to report all incidents appropriately and felt managers did not investigate all incidents. Lessons learned were not always shared effectively with the whole team. When things went wrong, we found the provider’s systems for duty of candour were not always effective and patients were not adequately supported when they raised concerns.
  • Staff did not always have easy access to clinical information, and it was not easy for them to maintain high quality clinical records, whether paper-based or electronic.
  • Risk assessments were not always personalised, completed to a good quality or appropriate. We saw examples of risk increasing after control measures were put in place. Risk scoring was inconsistent; the outcome of the risk assessments was classed as being higher than that indicated by the scoring.
  • Care plans were not always goal-specific and lacked detail. The care plans and notes did not always refer to the patients’ diagnoses or risk assessments, nor was it always evident there was a multi-disciplinary team approach. There was limited reference to patient discharge in care plans and/or care notes. Care plans lacked detail in several places, especially around treatment plans for medication; and we found plans were not always consistently reviewed in the light of change.
  • Staff from different disciplines did not always work together as a team to benefit patients. They did not always support each other to make sure patients had no gaps in their care. The ward teams did not have access to the full range of specialists required to meet the needs of patients on the wards. The entire psychology team has recently resigned and as such patients did not have access to psychological therapy or care. There were examples of therapeutic advice being overridden by clinical nurse managers which then impacted on the quality of care being given to the patients. Following the inspection, the provider told us a psychologist had been successfully recruited.
  • The service did not always adequately support patients to raise complaints. Nor did they share learned lessons with the whole staff team and the wider service. We saw examples of investigations where the patient’s Independent Mental Health Advocate (IMHA) had not been invited to support the patient. Following the inspection, the Independent Mental Health Advocacy team told us communication with the service had improved.
  • Staff did not always support patients to have a healthier lifestyle by encouraging them to be active. Patients did not have access to a range of social, cultural and leisure activities as well as education and vocational resource in the wider community.
  • Some wards did not meet the needs of all patients who used the service including those with a protected characteristic. Rudyard ward had not had a dementia friendly assessment despite being the predominant ward for care of older people with mental health problems. Staff did not always help patients with communication and advocacy support.
  • Staff told us that managers were not always visible, and some were not approachable. Staff gave examples of feeling unsupported and demoralised. Staff suggestions for improvement in patient care were not always acted on. In addition, there were examples of staff being dismissed from their role by managers when raising concerns. Staff told us they felt a blame culture had developed that meant they were reluctant to speak with managers.
  • The provider did not always operate effective governance processes throughout the service and with partner organisations. Managers were unable to provide assurance about the safety of the service. Infection prevention and control audits were not always completed, and it was unclear if actions arising from audits had been completed. Investigations including root cause analysis were not always completed to a good standard, there was a lack of consistency and learning from investigations was not always included.
  • Teams did not always have access to the information they needed to provide safe and effective care or use that information to good effect. Not all staff had access to the electronic systems which meant they were heavily reliant on the paper records being up to date. Not all staff knew where to find risk assessments or care plans.

However:

  • 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.
  • The provider was working with the multi-agency review team to address concerns raised in relation to IPC. However, it was too soon to gain assurance that those changes were fully imbedded and sustained.
  • At the time of inspection, there was one hospital manager responsible for both John Munroe Hospital and Edith Shaw Hospital. After the inspection, the provider shared plans to reorganise their management structure to ensure each ward had their own manager.
  • There had been an improvement in the quality of investigation report templates and reporting into patient complaints. Patients knew how to complain or raise concerns.

As this service has been rated inadequate it will be placed into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection areas

Safe

Inadequate

Updated 27 April 2021

Effective

Requires improvement

Updated 27 April 2021

Caring

Requires improvement

Updated 27 April 2021

Responsive

Inadequate

Updated 27 April 2021

Well-led

Inadequate

Updated 27 April 2021

Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Inadequate

Updated 27 April 2021

We rated this service as inadequate for safe and well-led and requires improvement for effective, caring and responsive. Our concerns related to the lack of good governance arrangements, poor infection prevention and control practices, a lack of therapeutic input to support rehabilitation and a culture whereby staff were not supported to speak up.

Wards for older people with mental health problems is a small proportion of hospital activity. The main service was long stay rehabilitation mental health wards for working age adults. The concerns related to both core service frameworks and as such we have reported findings for both under the long stay rehabilitation mental health wards for working age adults’ section.

Wards for older people with mental health problems

Insufficient evidence to rate

Updated 10 November 2020