Archived: Milestones Hospital

Updated 26 April 2021

Milestones Hospital is an independent mental health hospital that provides support and treatment, with a rehabilitation focus, for up to 18 women with complex and challenging mental health disorders.

The hospital is registered to carry out the following regulated activities:

• Treatment of disease, disorder or injury
• Assessment or medical treatment for persons detained under the 1983 Act

The hospital had 10 beds in Magnolia House and capacity to provide accommodation and care for up to eight patients in the Mews which is a separate building within the grounds with self-contained flats. At the time of inspection 12 patients were admitted, 10 of whom were detained under the Mental Health Act, in Magnolia House with two being informal patients (those in the Mews).

The service had not had a consistent registered manager since April 2020. A manager was employed between June and September 2020 but did not formally register with the CQC. The service had a temporary unregistered manager between September 2020 and January 2021 when a new manager was employed on 13 January 2021.

The service was last inspected in March 2020 and was rated as requires improvement overall and within the safe, responsive and well led domains with caring and responsive rated as good.

Updated 26 April 2021

This inspection was an unannounced, focused inspection in response to concerns we had in relation to patient safety, incident management, safe staffing and the use of restraint.

We looked at specific key lines of enquiry during this inspection therefore we have reported in the following domains:

• Safe
• Well-led

Following our inspection, we issued an urgent Notice of Decision to restrict further admission among a number of other conditions. In the following weeks after the inspection the service notified us that it had became insolvent and all patients were relocated to other services prior to it closing.

We changed the ratings for Milestones Hospital to inadequate for Safe and Well-led and suspended the ratings for Effective, Caring and Responsive because:

• The service did not ensure that patients met the inclusion/exclusion admission criteria and were unable to meet the needs of some patients with complex conditions.
• The ward environment was not always safe. Patients were frequently able to access items to cause deliberate self-harm and the hospital had high numbers of deliberate self-harm incidents requiring treatment at the local acute hospital emergency department.
• Staffing was not structured in line with patient acuity and clinical need. Staffing levels did not always ensure enough staff were available to maintain patient enhanced observations.
• The provider had not ensured that patient observations were completed in line with patient care plans or the provider’s patient observation policy. We saw closed circuit television (CCTV) footage where staff failed to complete enhanced patient observations for prolonged periods of time and falsified records.
• The provider did not ensure that all staff completed or were up to date with their mandatory training. Only 27% of staff had completed their physical intervention training and only 41% of staff had completed first aid training which included basic life support training.
• Staff did not always manage risks to patients well. Patients did not always have adequate nursing assessments, associated care plans, risk assessments and positive behaviour support plans in place to enable staff to safely manage patients. Staff did not always act to prevent or reduce risks or respond to changes in patient risks.
• The service did not always manage patient safety incidents well. Managers did not fully investigate incidents and learning from incidents was not always completed or shared with staff. Staff did not always complete post incident checks with patients including checking for injuries or completing body maps.
• Our findings demonstrated that the provider’s governance processes were not operating effectively. Although they had identified where improvements were needed to provide safe care, these were not implemented. The process for managing risk was inconsistent and ineffective. Senior leadership was reactive rather than proactive in identifying issues around risk and performance. They were not supporting the team to deliver care that was consistent and effective when caring for patients with complex and challenging behaviours.

Updated 26 April 2021

This inspection was an unannounced, focused inspection in response to concerns we had in relation to patient safety, incident management, safe staffing and the use of restraint.

We looked at specific key lines of enquiry during this inspection therefore we have reported in the following domains:

• Safe
• Well-led

Following our inspection, we issued an urgent Notice of Decision to restrict further admission among a number of other conditions. In the following weeks after the inspection the service notified us that it had became insolvent and all patients were relocated to other services prior to it closing.

We changed the ratings for Milestones Hospital to inadequate for Safe and Well-led and suspended the ratings for Effective, Caring and Responsive because:

• The service did not ensure that patients met the inclusion/exclusion admission criteria and were unable to meet the needs of some patients with complex conditions.
• The ward environment was not always safe. Patients were frequently able to access items to cause deliberate self-harm and the hospital had high numbers of deliberate self-harm incidents requiring treatment at the local acute hospital emergency department.
• Staffing was not structured in line with patient acuity and clinical need. Staffing levels did not always ensure enough staff were available to maintain patient enhanced observations.
• The provider had not ensured that patient observations were completed in line with patient care plans or the provider’s patient observation policy. We saw closed circuit television (CCTV) footage where staff failed to complete enhanced patient observations for prolonged periods of time and falsified records.
• The provider did not ensure that all staff completed or were up to date with their mandatory training. Only 27% of staff had completed their physical intervention training and only 41% of staff had completed first aid training which included basic life support training.
• Staff did not always manage risks to patients well. Patients did not always have adequate nursing assessments, associated care plans, risk assessments and positive behaviour support plans in place to enable staff to safely manage patients. Staff did not always act to prevent or reduce risks or respond to changes in patient risks.
• The service did not always manage patient safety incidents well. Managers did not fully investigate incidents and learning from incidents was not always completed or shared with staff. Staff did not always complete post incident checks with patients including checking for injuries or completing body maps.
• Our findings demonstrated that the provider’s governance processes were not operating effectively. Although they had identified where improvements were needed to provide safe care, these were not implemented. The process for managing risk was inconsistent and ineffective. Senior leadership was reactive rather than proactive in identifying issues around risk and performance. They were not supporting the team to deliver care that was consistent and effective when caring for patients with complex and challenging behaviours.