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Inspection Summary


Overall summary & rating

Good

Updated 3 March 2020

Potters Bar Clinic offers Child and Adolescent Mental Health Services (CAMHS) Tier 4 low secure services for young people aged 13 to 18 with a wide range of disorders and complex needs.

The hospital also has two acute wards for adults of working age, one for male and one for female patients.

We rated Potters Bar Clinic as good because:

  • We examined all care records for patients and young people. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating and de-escalating violence and aggression.
  • Ligature risk assessments were available on all of the wards along with heat maps which are diagrams which show the high-risk ligature points. Staff undertook regular ligature risk assessments of the wards.
  • Staff developed comprehensive care plans for each young person and patient that met their mental and physical health needs.
  • We examined six weeks of the duty rotas on each of the wards and found that the number of nurses and healthcare assistants matched the expected numbers on all shifts. Bank and agency staff members were block booked and were familiar with the wards young people and patients. All bank and agency staff had received appropriate training as well as an induction to the ward prior to their allocated shift.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ and young peoples’ rights to them. Mental Health Act training figures were at 91% at the time of inspection.
  • Staff treated patients and young people with compassion and kindness. We saw discreet, respectful and responsive interactions.
  • Staff supported the young people with activities outside the service and made sure young people had access to education throughout their time on the ward. There was a school on site and teachers also attended the wards to provide one to one education to patients.
  • Managers were resilient and had a strong drive for improvement. There was good oversight of safeguarding, incidents, observations and notifications to external bodies across the hospital. Management of risk and risk registers had improved significantly.
  • Staff that we spoke with felt respected, supported and valued. They felt the service promoted equality and diversity and provided opportunities for career development.

However:

  • Ward re-decoration was necessary on the adult acute wards as some areas were shabby, dirty and needed deep cleaning. The ward redecoration and kitchen refurbishment was on a scheduled log for completion.Some basic maintenance issues had not been dealt with in a timely way.
  • Managers monitored compliance with mandatory training. Most training had a compliance rate of over 75%. However, safe administration of medications was low at 52%. Infection control (level 1) at 68% and level 2 at just 50%. Suggestions, ideas and complaints, and the management of violence and aggression had a 71% compliance rate.
Inspection areas

Safe

Requires improvement

Updated 3 March 2020

We rated safe as requires improvement because:

  • The acute ward environments required some attention. Both Ruby and Crystal wards were minimally furnished although there was adequate seating and space available. We saw that the wards were not clean in all places. Blinds were dirty; windows needed cleaning; as did the window shields and window sills. Walls were marked and scuffed and required re-decoration. The ward redecoration and kitchen refurbishment was on a scheduled log for completion. Some curtains were absent in communal areas. We were later told that these had been sent for cleaning after a patient had pulled them down. Cleaning schedules were not available and we were not assured that the cleanliness and maintenance of the adult wards had been a priority.

  • Managers monitored compliance with mandatory training. Most training had a compliance rate of over 75%. However, safe administration of medications was low at 52%. Infection control (level 1) at 68% and level 2 at just 50%. Suggestions, ideas and complaints, and the management of violence and aggression had a 71% compliance rate.

  • Staff sickness was high at 40% on Jasper ward and 59% on Opal ward between 01 January 2018 to 31 July 2019. Managers did not have oversight of staff sickness as although there was an electronic system in place, staff that we spoke with did not know how to use it.

  • During interviews, some staff could not give examples of lessons learnt following incidents. We noted that there was an incident involving a patient bringing in a contraband item. A similar incident then re-occurred a short time after. We were not assured that learning was always taking place effectively. One emergency bag check on the adult ward was inaccurate, as an item that staff had signed as present and correct, had expired in October 2019.

However:

  • We examined all care records for patients and young people. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating and de-escalating violence and aggression.

  • Ligature risk assessments were available on all the wards along with heat maps which are diagrams which show the high-risk ligature points. Staff undertook regular ligature risk assessments of the wards.

  • We examined six weeks of the duty rotas on each of the wards and found that the number of nurses and healthcare assistants matched the expected numbers on all shifts. Bank and agency staff members were block booked and were familiar with the wards young people and patients. All bank and agency staff had received appropriate training as well as an induction to the ward prior to their allocated shifts.

Effective

Good

Updated 3 March 2020

We rated effective as good because:

  • Staff assessed patient’s physical health upon admission or shortly after. Staff continued to assess physical health regularly throughout the admission.

  • Staff developed comprehensive care plans for each patient that met their mental and physical health needs.

    Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ and young peoples’ rights to them. Mental Health Act training figures were at 91% at the time of inspection.

  • The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. This included doctors, qualified nurses, psychologists, social workers and occupational therapists.

  • Staff assessed and recorded consent and capacity or competence clearly for patients who might have impaired mental capacity or competence.

  • We saw that staff informed and involved families and carers appropriately. Managers recognised that some families lived a distance away, and were flexible with visiting, to enable regular contact.

Caring

Good

Updated 3 March 2020

We rated caring as good because:

  • Staff treated patients and young people with compassion and kindness. We saw discreet, respectful and responsive interactions.

  • Staff involved patients in decisions about the service, when appropriate. Staff held weekly community meetings on the wards.Staff acted upon requests and fed back to the patients.

  • We reviewed 17 “leaving our service” questionnaires that patients had completed. Overall these were positive. We noted that 11 out of 17 patients would be likely or highly likely to recommend the service to family or friends.

  • Staff informed and involved families and carers appropriately. If patients granted permission, staff invited carers to meetings, reviews and Mental Health Tribunals. Staff sent carers copies of relevant meeting minutes and offered a weekly update on their loved one.

  • The service held regular carers days in which carers could see patient facilities, meet staff and gain additional support from the service and other carers.

Responsive

Good

Updated 3 March 2020

We rated responsive as good because:

  • Staff supported patients with activities outside the service and made sure young people had access to education throughout their time on the ward. There was a school on site and teachers also attended the wards to provide one to one education to patients.

  • Staff helped patients to stay in contact with families and carers.

  • The service met the needs of all patients, including those with a protected characteristic. Staff helped patients with communication, advocacy, as well as cultural and spiritual support. Each first-floor ward had a larger bedroom suitable for patients who used wheelchairs. the use of a wheelchair, with an internal lift to enable access.

  • Between 13 March 2019 and 12 September 2019, bed occupancy was reported to be 84% on Crystal ward, and 93% on Ruby ward. Staff managed beds well. There was always a bed available when patients returned from leave. Patients were not moved between wards during an admission episode.

  • Staff could obtain information on treatments, local services, how to complain, and Mental Health Act information in different languages, and use an interpreter / signer where needed.

  • Information was available in easy read format for individuals who needed this.

Well-led

Good

Updated 3 March 2020

We rated well-led as good because:

  • Staff that we spoke with felt respected, supported and valued. They felt the service promoted equality and diversity and provided opportunities for career development.

  • Teams were resilient and cohesive and worked well together. Managers dealt with any difficulties appropriately.

  • Managers were resilient and had a strong drive for improvement. There was good oversight of safeguarding, incidents, observations and notifications to external bodies across the hospital. Management of risk and risk registers had improved significantly.

  • Managers supported staff to develop their skills and take on more senior roles. There were opportunities for health care assistants to achieve the level three diploma in healthcare support.

  • Staff, young people and carers could access information about the work of the provider through the intranet, bulletins and newsletters. The young people and their carers had the opportunity to give feedback on the service. Managers reviewed all feedback.

  • Managers had worked on developing relationships with carers by holding regular carers events at the service. They had also held meetings with the local Police and local authority safeguarding in order to work cohesively together.

However:

  • Managers failed to ensure that all basic maintenance issues were completed promptly.

  • The provider did not always ensure that clinical governance meetings were effective and did not always demonstrate that issues arising were resolved quickly. This included the effective oversight of sickness, medication stock and grab bags.

Checks on specific services

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 3 March 2020

Child and adolescent mental health wards

Good

Updated 3 March 2020