Rhodes Wood Hospital

We did not rate this inspection. The ratings from the inspection which took place 09 to 11 April 2019 remain the same. This was a focused, unannounced inspection, to follow up on enforcement action we issued to the provider after our last inspection.

At the last inspection, we issued enforcement action because the provider was failing to provide safe care and treatment to young people. The provider was required to make significant improvements in different areas. These, specifically were:

• the safe management of ligature risks
• staff knowledge, understanding and implementation of seclusion
• staff response to alarms
• thorough checking of emergency bags
• infection control
• timeliness and completeness of individual patient risk assessments
• the safe management of Section 17 leave.

During this inspection, we found some areas of significant improvement. The provider had acted upon previous concerns raised. Therefore the warning notice has been lifted. However, we did serve an urgent notice of decision, around the management of seclusion and long-term segregation.

Ligature risk assessments identified all potential ligature risks across the hospital. Each risk contained mitigation, so staff knew how to manage identified risks. Staff knew where ligature risk assessments were, and could refer to them easily.

The provider had invested in a new alarm system across the hospital. All clinical staff carried personal alarms. Alarms were routinely tested and charged to ensure they were in full working order. When an alarm was activated, it sounded across the hospital. Viewing panels had been installed in all three wards, which directed staff to the location of the alarm.

Nursing staff checked all three emergency bags across the hospital regularly. All equipment and medicines which should have been present, were present. Staff had recorded contents accurately.

Staff adhered to infection control when disposing of both general, and clinical waste across all three wards. Nursing staff had appropriately labelled sharps bins, used these appropriately, and they were not over filled.

Staff completed an individual risk assessment of each young person upon, or shortly after admission. Risk assessments contained appropriate and up to date information around risks, to include how staff managed these as safely as possible.

Doctors recorded the parameters of authorised leave clearly.  Specific duration of leave was stipulated for all young people. Staff recorded the names of escorts in most instances. Staff, where appropriate, had identified and recorded details of the home address for when young people were to reside with parents. Staff recorded episodes of leave, including views on how the leave went, from young people, staff or family members / carers as appropriate. Staff had implemented and discussed contingency plans with young people, in case leave did not go as well as expected.

However,

Staff were not clear as to what seclusion and long-term segregation was, and could not clearly explain the differences between the two. Seclusion and segregation paperwork had been put in place so staff could record any instances. However, the paperwork was incomplete and not comprehensive. We found a lack of care planning, and limited records to show reviews of young people in seclusion or long term segregation had taken place. We could not ascertain, in a number of records viewed, the length of time the seclusion or segregation had lasted. Secluding or segregating young people for any longer than absolutely necessary is an infringement of their human rights. We were not assured that staff understood or followed, the Mental Health Act Code of Practice, in relation to seclusion and segregation safeguards.

Summary of findings

We rated Rhodes Wood hospital as inadequate because:

• Staff did not assess, monitor or manage risks to people who use the services appropriately. Ligature risk assessments did not identify all potential ligature risks. Mitigation was not robust. Ligature risk assessments were not held on the wards. Risk assessments were not always completed in a timely way following admission. Formal risk assessments were not comprehensive. Some patients did not have risk management plans.

• The hospital did not take sufficient action to minimise risk to patients and staff. We identified numerous reportable incidents involving the police, paramedic assistance, and patient transfers to general hospitals which had not been reported to CQC. Staff had not consistently informed CQC when they had raised safeguarding concerns. There were three mandatory training courses with compliance of 60% or under. Conflict resolution (60%); breakaway (59%) and basic life support at only 53%.

• Systems were not always reliable or appropriate to keep people safe. Staff did not routinely test or carry personal alarms, although there were call bells in most rooms. When an alarm was pressed, it only sounded in office areas. Staff reported that there would often be a delay in response when needed. Nursing staff checked emergency bags daily. However, we found discrepancies in what was recorded as being present, against what was present. This included emergency medication.

• Staff did not always adhere to the Mental Health Act Code of Practice. We identified two instances where staff had secluded patients for a short period of time. Staff did not recognise this as episodes of seclusion. It was therefore not reported as seclusion. We identified staff had not been managing section17 leave robustly. Staff were not always certain of the parameters of leave granted and recording of leave was often brief. Not all patients had contingency plans if things went wrong while on leave.

• The wards were dusty, unclean and poorly maintained. Some areas needed re-decoration. Some walls were scuffed in one area and had been written on by patients. Staff did not report or address maintenance issues consistently or in a timely way. There were significant gaps in the cleaning records. They did not indicate when Mymwood Place had last been properly cleaned. Staff used clinical waste bags for general rubbish. Nurses had disposed of rubbish in sharps bins. We were not assured that staff viewed infection control as a priority.

• There were gaps in management and support arrangements for staff. Managers were not providing nurses and therapeutic care workers with regular clinical supervision.

• Records sampled confirmed this. Not all eligible staff had received an appraisal. Some staff had not been supported following incidents.

However:

• There was an adequate number of staff and staff were a visible presence on all wards. Most bank and agency staff had worked at the hospital frequently and so knew the patients.
• Managers shared learning from incidents, investigations and complaints with all staff. They did this during team meetings, multi-disciplinary meetings, supervision (when it occurred) and through emails and posters. There was emphasis upon lessons learnt and striving to improve patient experience.
• Staff ensured that patients had easy access to independent advocates and supported patients as needed. Staff encouraged patients to keep in contact with families, carers and appropriate others. Staff accommodated visits at the hospital if patients were too ill to leave the hospital grounds.
• Patients and carers described staff as caring and helpful.
• Staff understood the individual needs of patients. Staff facilitated young people’s access to education throughout their time on the wards. Each patient had a weekly individual time-table. This included education, therapy and leisure activities.
• Leaders had the skills, knowledge and experience to perform their roles. They were visible and approachable for patients, staff and carers.