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John Munroe Hospital - Rudyard Requires improvement

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

Requires improvement

Updated 9 May 2018

We rated John Munroe hospital as requires improvement because:

  • We saw that provider had made improvements since our last inspection. The provider had resolved some of the issues that we had identified or had started to make improvements but there was further work to complete. However, there were still improvements that the provider needed to make in other areas.

  • We saw there was still a blanket restriction in place. On Kipling ward patients did not have free access to a toilet without asking staff permission. This general restriction was not justified although it may have been in the interests of a few patients on the ward.
  • The hospital did not always follow best practice in relation to gender separation requirements; there was not a female only area on Rudyard ward.
  • Staff did not have consistent access to supervision and appraisals. There had been an improvement in appraisal completion, but supervision and appraisal completion were still an issue on Rudyard; approximately 10% of staff had received regular supervision in the year prior to our inspection and 45% of staff had an appraisal.
  • The ligature risk policy was out of date and an environmental ligature risk assessment for Kipling ward was out of date. Staff did not always update ligature risk assessments where individual patient’s risk was recorded and were not assessing risks in line with policy.
  • We did not find evidence that learning from incidents; patient feedback or complaints took place at team meetings. Team meetings took place regularly on only three of the five wards. The hospital had introduced a lessons learnt bulletin in December 2017 to share learning more regularly but most staff were not familiar with this.
  • Most staff did not understand what duty of candour was and could not describe why it was important.
  • All patients had a care plan but these did not always demonstrate a recovery focus or personalisation. Active involvement in care planning was not always evident; it was not always clear whether patients had received a copy of their care plan.
  • The provider did not maintain comprehensive records of the activities offered to and taken up by patients. Individual therapists maintained records but there was no overall summary of the provider offering support to engage patients in activities that aimed to assist them to gain skills for their rehabilitation.
  • Staff did not know the values of the organisation. Staff described a ‘disconnect’ between the most senior management on the board and the hospital staff. There had been a low level of feedback from the staff survey.

However:

  • There were effective processes in place to ensure staff implemented the Mental Health Act properly. The Mental Health Act manager supported the wards and ensured that mental health act processes were regularly audited and that staff were supported in relation to the act.

  • Staff had a good understanding of safeguarding, staff had completed training and there were effective processes in place for safeguarding. Overall, mandatory training figures had improved since our last inspection. Staff compliance was at 92%. There were effective processes to monitor and implement training.
  • Staff said they felt comfortable to raise concerns and knew how to whistle-blow and said they would do if needed. The provider had a ‘freedom to speak up guardian’ who staff could raise concerns with directly. Staff were positive about the support they received from managers throughout the hospital including the hospital manager.
  • Staff demonstrated that they knew and understood patients’ needs, preferences and risks. Staff ensured risk assessments were up to date, thorough and reviewed regularly. Clinical items and areas were clean, the integrity of mattresses was audited and staff completed checks of emergency equipment.
  • Staff managed patients’ often chronic and complex physical health problems well. The service had a GP who saw patients regularly. Staff promoted healthy lifestyles and supported patients to make healthy choices
  • Staff treated patients kindly and respectfully. We saw staff had a good rapport and were kind and sensitive to patients’ needs. Carers and family members were positive about the care of their loved ones, they felt appropriately involved with care and were happy with the way staff communicated with them about patients. Overall patients and carers were satisfied that patients’ belongings were safe.

 

Inspection areas

Safe

Requires improvement

Updated 9 May 2018

We rated safe as requires improvement because:

  • We saw evidence of a blanket restriction in place on Kipling ward. The toilets were locked and patients were unable to access them without asking staff. There had been risks identified for three patients using the toilet freely but the restriction had been applied to all patients.

  • Rudyard ward was a mixed gender ward, but there was no female only lounge or communal area. There were two women on the ward at the time of our inspection. On mixed wards good practice requires a day lounge for use by women only. However, the provider changed this shortly after our inspection and Rudyard ward is now a male only ward.

  • We observed dirty wheelchairs on the Rudyard ward and different patients used these. A member of staff told us there was no clear process for cleaning wheel chairs. This was an infection control issue.

  • On Larches, the emergency adrenaline was not stored where it should have been, this would have made it difficult to find if staff had needed to use.

  • Not all portable electrical equipment had been tested to check that it was safe to use. We saw that this was not in line with the provider’s maintenance policy.

However:

  • Staff ensured individual patients’ risk assessments were up to date and reviewed regularly. Risk assessments were thorough, individualised, and covered relevant risks.

  • Clinic rooms were well equipped and clean and staff checked emergency resuscitation equipment and recorded when they had done this.

  • The wards were visibly clean and tidy. Cleaning took place and staff recorded when this had been completed. Staff audited mattresses and took action to replace mattresses when necessary.

  • There were enough trained staff to carry out physical interventions and all staff including bank and agency staff were trained in carrying out restraint.

Effective

Requires improvement

Updated 9 May 2018

We rated effective as requires improvement:

  • Supervision and appraisals did not always take place. There had been an improvement in appraisal compliance. However, on Rudyard ward only two members of staff had been supervised, the provider said they thought this was approximately 10% of staff and only 45% of staff had received an

  • All patients had a care plan but on High Ash and Horton these did not always demonstrate a recovery focus or that they were person centred. Staff had not consistently evidenced that evident that the patients’ preferences had been considered.

  • Staff meetings should have taken place once every three months in each clinical area to meet the local standard. However, this had not happened. On Horton, team meetings had not taken place in the last six months and on High Ash, there had been one team meeting take place in the last six months. The other three wards had held regular meetings. Team meetings did not have a set agenda to ensure specific issues were communicated hospital wide and there were no action points from these meetings.

  • At our last inspection, we identified that staff had not completed dementia training; on Rudyard, the majority of patients had dementia. Since our last inspection, 37% of staff had completed this training.

However:

  • Staff managed patients’ physical health well. Many patients at the hospital had complex physical health needs. There was a GP that the provider commissioned who regularly reviewed and monitored patients’ health. Patients saw specialists when required and staff supported patients to live healthier lives.

  • Mental Health Act paperwork was stored correctly and regularly audited. The Mental Health Act manager supported staff with implementation of the Mental Health Act and provided the wards with up to date policies concerning the Mental Health Act.

  • Clinical staff completed audits these included medicines and prescribing audits and audits of the environment and infection control.

  • Staff received a thorough induction. All staff received mandatory training on induction and had time to shadow staff on the ward before they started to work. Health care assistants completed training in line with the care certificate standards.

Caring

Good

Updated 9 May 2018

We rated caring as good because:

  • We saw positive interactions from staff towards patients. We saw staff having a good rapport and being kind and sensitive to patients’ needs. Patients told us staff were respectful and maintained their privacy.

  • Staff had a good understanding of patients’ needs and preferences and were focused on positive outcomes for patients.

  • Patients had access to advocacy and the Independent Mental Health Advocates told us that staff made regular referrals to them.

  • Carers and family members were positive about the care of their loved ones. There was evidence that carers were involved in treatment decisions and invited to meetings. Carers told us that staff communicated about their loved one’s progress.

However:

  • Active involvement in care planning was not always evident. There was not always evidence that patients received a copy of their care plan.

  • There were patient meetings where patients could give feedback about the service, but these did not always take place regularly and there were no action points from these meetings.

Responsive

Good

Updated 9 May 2018

We rated responsive as good because:

  • Patients were able to personalise their bedrooms and the staff actively supported this. Patients were able to store their belongings securely and if appropriate could have access to a safe in their rooms. Overall patients and carers were happy that belongings were safe.

  • Patients had access to outside space. John Munroe hospital was set in large and well looked after grounds.

  • The hospital worked closely with a local church, patients could attend church services at the hospital or if appropriate at the local church. Staff ensured that they met patients’ spiritual and cultural needs.

  • There had been a low level of complaints to the hospital, staff understood the complaints process and supported patients if they wanted to complain. Patients and carers knew how to make a complaint and felt confident to do so.

  • The hospital catered adequately for patients with dietary needs. The catering staff catered to patients’ religious, cultural or personal food choices. We saw examples of this during our inspection. Most patients were happy with food choices.

However:

  • Staff did not think there was enough access to activities for patients. We did not consistently see activity taking place on all wards. We did see some good examples of patients engaging in activities. However, it was not possible for us to assess whether there was enough activity for patients to aid their recovery and rehabilitation because the provider did not keep accessible and comprehensive records of activity levels for individual patients.

  • Information displayed for patients was limited. It was not always in an accessible format suitable for patients to easily read and understand. Menus were not displayed on the wards, we had identified this as an issue at our last inspection.

  • Rudyard ward was not an ideal environment for patients with dementia. Some improvements had been made since our last inspection however, corridors were narrow and there were limited aids for patients with mobility problems. The lounge was small and could be noisy and this could potentially increase patients’ levels of distress. However, the provider did have plans in place to move the ward to a different area of the hospital.

Well-led

Requires improvement

Updated 9 May 2018

We rated well led as requires improvement because:

  • The hospital did not ensure that staff received feedback from incidents, complaints and service user feedback. There was little evidence that learning was shared directly with staff at individual supervision or at team meetings or handovers. Where the hospital had tried to improve this with a learning lessons folder introduced in December 2017, the ward staff were unaware of this. This initiative was not well known among staff. Staff did not always share information about incidents with patient’s family or carers.

  • The ligature risk reduction policy for the hospital was out of date and staff were not assessing environmental risks in line with policy.

  • Most staff did not understand the duty of candour and could not describe to us why it was important.

  • Staff did not know the values of the organisation or understand how they were reflected in their team objectives. Staff described a ‘disconnect’ between the most senior management on the board and the hospital staff.

  • The hospital did not provide us with feedback from their most recent staff survey when we requested this. This had been the case at our last inspection. The provider told us that they discounted the feedback from this as only 28% of staff had responded and they did not feel the feedback demonstrated the views of staff from across the organisation.

However:

  • Safeguarding procedures were clearly set out and staff understood these. Staff compliance levels for safeguarding training were high at 92%. There was a thorough monitoring and auditing system for both Mental Health Act and Mental Capacity Act procedures.

  • Staff mandatory training figures had improved since our last inspection. Staff compliance levels across the hospital was at 92%. Training was well organised and efficiently monitored.

  • Staff knew how to whistle blow and said they would do if needed. The provider had appointed to the role of a ‘freedom to speak up guardian’. Staff could now raise concerns directly with the guardian.

  • Staff were complimentary about how their teams worked together and supported each other. They were positive about the support they received from both the hospital manager and the deputy service manager.

Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Updated 29 January 2019

Wards for older people with mental health problems

Requires improvement

Updated 9 May 2018