• Mental Health
  • Independent mental health service

St Neots Neurological Centre

Overall: Requires improvement read more about inspection ratings

Howitts Lane, Eynesbury, St Neots, Cambridgeshire, PE19 2JA (01480) 210210

Provided and run by:
Elysium Healthcare No.2 Limited

Important: The provider of this service changed. See old profile

All Inspections

9 and 10 November 2022

During a routine inspection

St Neots Hospital provides long stay and rehabilitation wards for adults with severe and enduring mental health needs. It specialises in caring for patients with complex and co-morbid mental health and physical health conditions, including progressive neurological conditions and patients in the latter stages of their diagnosis.

We carried out this unannounced inspection as a follow up to a focused inspection that took place July 2020 and to review those parts of the service that did not meet legal requirements at that visit. We also carried out this inspection as we had received a number of recent whistleblowing concerns from staff at the hospital.

At the previous inspection we did not rate this service. The most recent comprehensive inspection was completed in August 2019 when we rated this service as good in all areas.

St Neots Neurological Centre provides long stay and rehabilitation wards for adults with severe and enduring mental health needs. There are 4 wards in the hospital on the same site Willow, Cherry, Rowan and Maple.

We rated it as requires improvement because:

  • There were no cleaning records for the clinic room and no cleaning records for clinical equipment, so no evidence to show that these areas and equipment were being cleaned regularly between patients.
  • Risk assessments for patients moving into the hospital often took a few months to be written and added to the computer system.
  • The hospital had not followed procedures after rapid tranquillisation for one patient. We were not able to find records to show that the patient had been observed afterwards and that the doctor had been informed.
  • Clinic rooms had out of date dressings and the grab bag had items not stored correctly.
  • Patients did not all have a discharge plan where appropriate.
  • The inspection team witnessed 2 staff speaking to each other in their first language in front of patients and not all staff were wearing name badges.
  • Care plans did not include spiritual needs for some patients who were at end of life.
  • Staff training was not at an acceptable compliance level of 75% on 6 occasions.
  • Staff did not always follow the hospital medication policy and procedure when recording medication.
  • It was not clear in one patient’s prescription chart and care plan who had several medications for the same mental health condition, when to use which.
  • The restrictive hospital environment resulted in patients sharing communal bathing facilities and quiet areas were limited.

However:

  • The service had enough nursing and medical staff, who knew the patients and received good training to keep people safe from avoidable harm. Staff on shift and on induction told us that the training they received by the hospital was very thorough and there was a comprehensive training programme for additional non mandatory training, which all staff could access. Managers used a training matrix to record mandatory training and used a traffic light system to alert managers when training had not been completed.
  • Staff assessed and managed risks to patients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients’ recovery. We observed a planned restraint, the patient was treated with dignity and respect, given choices and the process was well managed from start to end and staff avoided restraint using de-escalation techniques.
  • Staff told us each staff member had a password to access patients records, regular agency staff had a password and temporary agency could access the system using a one-time password.
  • Staff told us they received a debrief after serious incidents, this happened every morning at the hand over meeting. Carers told us managers investigated incidents promptly and thoroughly.
  • Staff discussed recent incidents during team meetings and lessons learnt posters were displayed on a quarterly basis in the hospital and in reception areas and included actions taken.
  • Staff managed physical health efficiently including using The National Early Warning Score to record any changes in patients' well being and assessed the physical and mental health of all patients on admission.
  • Care plans were holistic, goal orientated and reflect change. Care plans included physical and mental health, moving and handling, medication, finances and end of life plans, nutrition and communication. Each patient had a different person-centred model of care and a Meaningful Care Plan. Care plans were reviewed regularly through multidisciplinary discussion and updated as needed.
  • The hospital had a full multidisciplinary team 1 consultant neuropsychologist, 2 occupational therapists, 1 assistant psychologist, 1 physiotherapist, 1 social worker, 1 speech and language therapist and 4.6 therapy assistants. The therapy team were able to provide a full range of activities and therapies both in the ward and in the community.

14 July 2020

During an inspection looking at part of the service

St Neots Neurological Centre provides long stay and rehabilitation wards for adults with severe and enduring mental health needs.

We did not rate this service at this focused inspection. We carried out this inspection in response to a high number of whistleblowing concerns and concerns about how some patients had been supported.

We found the following issues that the provider needs to improve:

  • Staff had not always followed care plans and had not consistently kept patients safe from avoidable harm. Two patients had sustained injuries in incidents which could and should have been avoided.
  • Staff had not completed all patient records to a good standard. There were gaps in some falls assessments and recommendations were not always carried out or recorded.
  • Cleaning schedules for all wards were poorly recorded. Audits had not identified and addressed this issue.
  • There were insufficient computers on the wards for all staff to have easy access to patient records. Agency staff did not have access to the hospital’s computer system and had to rely on permanent staff, printouts and handovers which meant they could not be sure they had up-to-date patient information.
  • There was a lack of meaningful activities or personalised timetables for patients.

However, we found the following areas of good practice:

  • The ward environments were safe and clean. Managers had put systems in place to ensure that staff had access to personal protective equipment and that staff used it correctly. Managers adhered to company-wide processes to ensure they never ran out.
  • The wards had enough nurses and doctors and followed good practice with respect to safeguarding. 
  • Staff we spoke with felt respected, supported and valued. They felt able to raise concerns without fear of retribution. They were knowledgeable, confident and skilled when treating patients.
  • The provider gave thorough handovers and maintained detailed records for staff who were not present.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They involved patients and families and carers in care decisions.
  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.
  • Managers monitored the performance of the team. They were aware of the impact of Covid-19 in reducing supervisions, face to face training and team meetings but had plans in place to address this.

15th and 16th August 2019

During a routine inspection

We rated St Neots Hospital as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a long stay mental health ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service worked to a recognised model of mental health treatment. It was well led, and the governance processes ensured that ward procedures ran smoothly.

21 and 31 August 2018

During a routine inspection

We rated St Neots Hospital as requires improvement because:

  • There were some gaps in the updating of risk assessments and care and treatment plans particularly with regards to physical health care. Staff had not received falls prevention training and body maps for patients were not consistently completed. Care plans to manage the risk of pressure sores and falls prevention where relevant lacked detail. Only 69% of staff had current training in the prevention and management of violence and aggression.
  • Two items were found to be missing from the emergency grab bags. One from the first floor and one from the ground floor. One item had been missing for a month and not been replaced. The other had been signed as present but was not there. There were no clear reports of physical observations post rapid tranquilisation. Patient decisions to decline physical observations post rapid tranquilisation were not clearly documented. Discrepancies were identified in the administration and recording of ‘as required’ medicines.
  • Clinical audits carried out by staff had not identified the concerns we found during this inspection.
  • The hospital provided occupational therapy three days per week since August 2018. Until this point the hospital did not provide sufficient occupational therapy input to provide thorough assessments for all patients.

However:

  • The provider had addressed the requirements issued by the Care Quality Commission following the last comprehensive inspection which took place on 10 and 11 August 2017.
  • The provider had a monthly ward to board electronic dashboard that enabled the unit manager to see an overview of their service’s performance. This made reference to the Commission’s five domains and any actions arising were identified.
  • The hospital shared learning from incidents, complaints and feedback at monthly clinical governance meetings and monthly corporate governance meetings. This was confirmed by those minutes seen.
  • The provider reported that 85% of staff had received supervision in July 2018. This was confirmed by those staff spoken with and those records seen. These records confirmed that 94% of eligible staff had received an annual appraisal.
  • Front line staff had received specialist training in Huntington’s disease. This had been provided by the Huntington’s Disease Association. Nutrition and dysphagia training had been delivered by the speech and language therapist and dietician.
  • Staff monitored patients’ daily nutrition and hydration intake as required and recorded this. We noted that actions had been subsequently recorded as to how to address low fluid and food intake.
  • Ongoing recruitment was taking place to address the existing staff vacancies.
  • Staff attendance at mandatory training was 87%. Staff had been booked onto further training course where necessary.

10th - 11th August 2017

During a routine inspection

We rated St Neots Hospital as requires improvement because:

  • Mandatory training levels for staff were low with less than 75% of staff having completed six of the ten mandatory training sessions, Mental Health Act and Mental Capacity Act training figures were particularly low.
  • Not all staff were up to date with prevention and management of violence and aggression training.
  • The service had a local safeguarding procedure that was unclear and did not comply with the Care Act guidelines. The service investigated safeguarding incidents internally and did not record outcomes fully.
  • The service did not have a robust system for incident reporting and did not feedback learning from incidents to staff.
  • Staff did not have access to supervision and team meetings in line with the hospital’s policy.
  • The service did not have a robust complaints procedure. Complaints were not answered within timescale and outcomes were not shared with staff.
  • The service had not provided any psychological therapies for patients.

However:

  • The service had identified a number of concerns prior to inspection and had implemented new systems and plans to address these at the time of inspection.
  • Recruitment was in progress for new staff and we saw that the service had introduced regular supervision, training and team meetings.
  • The service had safe staffing levels and managers regularly reviewed levels to ensure patients had sufficient access to nursing staff.
  • The service had good medicines management systems in place.
  • Patients reported feeling safe and cared for by staff. We found that staff were caring, respectful and compassionate.
  • The service provided good access to physical healthcare and staff assessed and met patients’ physical healthcare needs well.