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Archived: The Huntercombe Hospital East Yorkshire

We are carrying out a review of quality at The Huntercombe Hospital East Yorkshire. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 24 November 2014

During a routine inspection

Overall we found that The Huntercombe Hospital East Yorkshire was safe, effective, caring, responsive and well led.

Patients and staff told us they felt safe in the hospital, there were good care plans, risk assessments and outcome tools being used and patients were fully involved in their care. We found that discharge planning started at the point of admission.

Overall patients spoken with gave positive feedback regarding staff saying they could approach them with any issues they had, and that staff treated them with respect.

All staff groups felt supported by managers and they had access to supervision sessions both group and individual and other peer to peer support.

Staffs understanding of the organisations vision and values were mixed, however clinical governance systems were in place which assisted the provider to monitor and improve the quality of care.

But we also found:

  • Staffs’ compliance with mandatory training was poor in some areas, but plans were in place to address this.
  • It was not clear how best interests were assessed and recorded and who was involved in determining the patients’ best interests if they lacked capacity to make decisions in these areas.
  • Patients stated that they often felt bored and did not enjoy the activities and there wasn’t as much choice as they would have liked.
  • We were told that de-briefing occurs after all incidents including episodes of seclusion. However some staff felt that this process was not as robust as it once had been and support could be better for staff following incidents
  • As at November 2014, the overall staff sickness among permanent staff was reported as 7.4%, of which three quarters were nursing and care staff.

Inspection carried out on 4 February 2014

During an inspection to make sure that the improvements required had been made

At this inspection we were supported by a specialist advisor and also two professional advisors from NHS England. The advisors/professionals worked alongside CQC and reviewed evidence to assist in making judgements on compliance.

Care planning systems had improved and patient’s files had been updated. There was evidence that patient's had been involved in their care planning. Systems were now in place to support patient's with weight management and they told us they were happy with activities.

One patient said to us “Staff have done a lot for me” with another patient stating “This is the best hospital I have been in.”

Staff were clear on their roles in relation to safeguarding with policies now in place and training being completed. Restraint was not used regularly in the hospital and staff had received training in de-escalation techniques.

Improvements had been made to the medication systems used in the hospital. However further improvements were required in order to ensure patient safety with regard to medication.

We found that the hospital environment was clean; work had been undertaken and remained in progress to help ensure patient safety.

Clinical audit systems had been improved and the new systems included a variety of topics which were reported to managers and reviewed at multi-disciplinary meetings.

We found concerns with information sharing and the handling of complaints, and relatives told us they did not feel involved.

Records were not handled securely and four incidents had recently occurred were data protection was compromised.

Inspection carried out on 16, 17, 18 September 2013

During an inspection to make sure that the improvements required had been made

Following the last inspection the provider had confirmed to us the actions they would take to achieve compliance. We visited the service following the latest date identified in their action plan for achieving compliance. We found that the provider remained non-compliant in all five areas reviewed.

When we spoke with patients they told us that the hospital was a “Settled environment”, they liked the way staff talked to them and they were now doing more activities. However, one person said that living in the hospital “Felt like a prison”.

We received varying comments from relatives of patients. Two relatives were satisfied with communication arrangements that were in place but another felt they were not kept informed. One relative said that their relatives care was “Brilliant”, but another had concerns about the patients personal hygiene needs not being met, and ligature risks for their relative. Two relatives raised concerns about patient’s weight and health. We found that, despite patients being overweight, there was no hospital approach to obesity. This did not promote patient’s general health needs and had the potential to create a risk of harm for some patients.

We found that care plans did not always include details of the latest needs of the patient; this included completion of antecedent, behaviour and consequence (ABC) charts and seclusion records. One management plan described seclusion rather than segregation which was how the patient was being nursed. Health check documents did not include comprehensive information and were not always accurate. For one patient monitoring of a health condition had not been supported by an up to date care plan. This lack of accurate and up to date information could have placed patients at risk of not receiving appropriate care and support.

The majority of records in relation to medication were accurate, with medication being ordered and stored appropriately and the Mental Health Act status of patients being recorded. We observed medication being administered appropriately. However we found three incidents when medication had not been administered as prescribed, with one example of tests results not being recorded appropriately. There had been an investigation into a medication error but we were unclear about the findings or lessons learnt in respect of this.

Staff were aware of the signs of abuse but no formal training had been given to staff on how the new safeguarding process worked and staff were not clear about the role of the local safeguarding adult’s team. This could have led to some incidents not being reported to the appropriate professionals. We found that a high number of reported incidents did not have investigation findings and consequently gave no learning opportunity for staff to minimise future risk. Additionally staff training on basic life support was only at a 57% completion rate. This meant that there was a risk that people would not receive emergency treatment promptly.

We saw that some changes had been made to the environment to make it more homely and that patients had been involved with this process. However, we visited the seclusion rooms and looked at both cleanliness and safety. We had concerns that the hospital audits had not identified any issues but that we found a mattress and blanket which were damaged and which did not meet a person’s dignity or health and safety needs. Sharp edges remained in these rooms and we identified new ligature risks.

We found that the provider had undertaken a lot of work in relation to clinical governance and audits. Audits including ligature audits had been implemented although we found that some of the audits were not robust as they had not identified the risks that we identified during the inspection. Managers told us how learning from incidents had taken place. However, when we spoke to staff they were unclear about learning opportunities.

The provider had commenced but not completed work against the Winterbourne recommendations. We were concerned that the recommendations from Winterbourne had been available for some time and the hospital had yet to fully respond to these.

At this inspection we found that there were examples of repeated non-compliance in a number of areas, including that a patient’s detention had lapsed, concerns about patient’s weight and the identification of ligature risks. There was a lack of evidence of sustained compliance and a lack of monitoring by the provider through their audit systems to ensure that standards had been met.

Inspection carried out on 14, 15 May 2013

During an inspection in response to concerns

We undertook this inspection in response to concerns that we had about the service and to assess compliance against previous areas of non compliance.

Patients told us that they were happy with the care provided. Interactions between patients and staff were positive and respectful.

Not all relatives felt that communication was good, arrangements for visiting varied and one person felt their relative had “Regressed” since moving there.

People’s needs were assessed but this information was not always transferred into authorised care plans that were reviewed. Patient’s legal paperwork was not always correct.

However patients were undertaking activities and receiving section 17 leave.

Staff were aware of reporting issues of safeguarding but the policies and procedures in place did not fully meet the required guidance.

We found concerns with medication in a number of areas for example, the use of an unlicensed medication and incorrect practices regarding administration of medicines.

Although some areas had been refurbished we did not see any assessments of environmental risk to patients and it was unclear if these areas met with the latest guidance. We had concerns with the safety and cleanliness of the seclusion room.

We found that concerns regarding the incorrect recruitment practices had been met.

Staff were supported to undertake training to assist in supporting people, although more specialised training could be undertaken.

We had a number of concerns in relation to the governance and clinical audits completed in the hospital. These were either not in place or not substantial enough to ensure that people were kept safe and free from the risk of harm. This included clinical risk assessments to ensure peoples safety. External audits and national benchmarking for current best practice was not taking place.

There was manager in post who staff felt was approachable and who could demonstrate her leadership qualities.

Inspection carried out on 5 April 2013

During an inspection in response to concerns

We undertook this review in response to concerns raised about the recruitment practices at the hospital.

We found that the hospital had not followed the correct recruitment practices and one doctor had been employed who did not have approved clinician status in England.

We found that this doctor had authorised the detention of a patient which meant that they had been detained illegally.

Inspection carried out on 15 March 2013

During an inspection to make sure that the improvements required had been made

We completed this visit to follow up on areas of previous non compliance.

We saw that there were now more nurses employed within the hospital and less agency hours were used. Additional hours were completed by staff known to the patients.

The hours provided across the wards reflected the level of support required on that ward and staff felt they could now take more breaks and attend meetings. Patients told us that activities had improved but on occasions section 17 leave was either confirmed very late or still cancelled due to staffing.

Training of staff was taking place but some gaps remained that required addressing.

Staff told us that they felt well supported and supervisions had started to take place for staff to support them in their role.

The policies and procedures had been reviewed so that they reflected the actual provider organisation and not the predecessor. Management review meetings took place regularly and patients told us they were involved in meetings about the hospital.

Inspection carried out on 12 December 2012

During an inspection to make sure that the improvements required had been made

We spoke with 10 people who lived in the hospital, three individual staff and the senior managers.

We found that work had been undertaken to change policy and practice within the hospital to help ensure that patients were supported through least restrictive practices.

Patients and staff told us there were less restrictions on patients and that blanket policies for searches no longer existed. Patients told us that life in the hospital was better.

Inspection carried out on 8, 9 November 2012

During an inspection in response to concerns

We spoke with staff, patients and the managers of the hospital. We visited, Burton ward with four patients, which provided medium secure care, Coxwold and York wards with six patients and Westwood ward with two patients all provided low secure care, Welton ward with two patients which provided intensive support.

Patients told us “Staff are supportive” and “Staff are good and helpful but there are a lot of rules. They all work hard to help me and the others, I trust them”.

Patients told us about restrictions, “The doors are locked to the kitchen and I have to ask staff. I am only allowed two snacks a day after 3 pm”. Some patients told us that searches were completed when leaving and returning to the hospital, if they refused to give their permission this would be cancelled. Patients also said leave was often cancelled due to a lack of staffing.

We observed that staff displayed a genuine concern for patients. However, there was a lack of staff and not all staff had the correct level of training or support.

We found concerns with care planning, rules for patients, seclusion, restraint and section 17 leave. Also that the environment was not suitable in the seclusion rooms and issued an urgent compliance action to the hospital due to the risk of injury.

The quality assurance systems were not robust to ensure risks were identified and practices safely met people's needs.

Inspection carried out on 4 April 2012

During an inspection to make sure that the improvements required had been made

Patients spoken with confirmed they had contributed to the formulation of their risk assessments and care and treatment plan and had received a copy of it. They also told us they were able to voice their opinions in meetings. Comments included, “I think my treatment is going well” and “I am listened to and can amend my plan if needed.”

Patients also told us they were able to access community facilities when on leave away from the hospital. They confirmed activities and therapies were arranged within the hospital.

Patients spoken with told us they felt safe in the hospital and would speak to staff if they had any concerns. One patient on one ward told us staff handled incidents between patients well. Patients told us they had received information about how to keep themselves safe and some told us they had completed safeguarding training.

Patients spoken with knew what medicines they were taking and said staff explained what they were for. They also confirmed that medicines were discussed in weekly multi-disciplinary meetings. One patient told us they were fully involved with their medicines and were self-medicating.

Patients spoken with told us that staff treated them with respect and responded quickly to their needs. Comments included, “The staff are great – there are no issues” and “If you need support or to talk, they are always available.”

Patients spoken with confirmed there were patient council meetings. They knew the name of the patient who represented their ward. One patient said, “Menu’s were changed by the patient’s council.” Patients also told us they had weekly meetings on the wards to discuss the plan of activities for the coming week.

Inspection carried out on 26, 27 October 2011

During a themed inspection looking at Learning Disability Services

We visited two units, York and Coxwald. There were seven patients living at York unit when we visited. We met and spoke with five patients in depth, to get their views of the service.

There were two patients living at Coxwald unit. We met and introduced ourselves to both patients and spoke with one patient in more depth to get their views of the service. The patients we spoke with gave positive feedback overall. Two patients out of the six we spoke with said that staff changes had made them less happy and secure. Most patients told us that they had a copy of their care plan and that they had a named nurse. That staff followed their care plans and that they felt well supported.

Overall, most patients said there was enough opportunity to participate in activities, although one patient said that they thought there should be more to do.

All the patients we spoke with told us that they had advocates and that overall, they felt safe. When asked about abuse everyone knew what this meant and said they that they had not seen anyone abused in the hospital. When asked about the way they were treated by staff most patients said staff were supportive. When asked about restraint, two patients said they had been restrained, but they did not raise any concerns about this.

We spoke with the relatives of four patients about how they felt about the care, treatment and support provided. Three relatives gave positive feedback about the service. One person told us that they had a good deal of respect for the nursing staff, but that the hospital was not the right environment for their relative. Again, three of the four relatives we spoke with mentioned that there had been a lot of staff changes.

The expert by experience and the family carer, who were part of our inspection team, said that there seemed to be a high level of security in the hospital generally. The relative of one patient said that the reception area did not feel very welcoming.

Inspection carried out on 29 November 2011

During a routine inspection

Our visit was over two days on the 28 and 29 November 2011. There was a team of five inspectors on the first day and three on the second day. Linden House had recently had a themed learning disability (LD) inspection on 27 and 28 October 2011. It specifically reviewed outcomes four, care and welfare and outcome seven, safeguarding, for patients who use the service with a learning disability. This mainly focused on two houses on the low secure unit, York and Coxwold.

As we did not want to duplicate the inspection work already carried out we focused this planned inspection on the medium secure unit and the low secure units which provides services for patients with a personality disorder. We also reviewed further outcome areas. We visited on the medium secure unit Kinston, a specialist unit for patients with Aspergers syndrome and Thorne where there is one patient in the ward who is nursed in long term segregation from the rest of the medium secure population. On the low secure unit we visited Westwood a low secure unit for patients with a personality disorder and York House to look the records of a patient who had been recently admitted.

From both of the inspections we have been able to evidence outcomes four, care and welfare of patients who use the service and outcome seven safeguarding patients who use the service for abuse were significantly better on the low secure unit than the medium secure unit.

Two of the patients on the medium secure unit told us they had a named nurse who they met with regularly to discuss and review their care plans. They were aware of the multidisciplinary team meetings and were invited into them. They felt informed and they told us they had their rights regularly explained to them.

One patient told us they liked Linden House and it was, “Better than the other places I’ve been to”. One person said, "It was like a family.”

Two patients told us about the activities they participated in such as playing football, tennis and going to the gym. One patient did mention these were sometimes restricted when there was not enough staff available to escort them. We were unable to talk to some patients due to their illness. However, we were able to evidence from the records they were not accessing many activities.

One patient on the medium secure unit told us they generally did feel safe but not if anyone, “Kicks off.” They told us staff would generally intervene if any incidents occurred.

Throughout this inspection we were able to evidence that patient’s rights were not always upheld, they were not always receiving appropriate and safe care, and sometimes there were insufficient staff which had resulted in poor outcomes.