The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Milestones Hospital

Overall: Inadequate read more about inspection ratings

The Street, Catfield, Great Yarmouth, NR29 5BE (01603) 782200

Provided and run by:
The Atarrah Project Limited

All Inspections

19 and 20 January 2021

During an inspection looking at part of the service

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.

4 & 11 March 2020

During a routine inspection

The Milestones hospital provides support and treatment, with a rehabilitation focus, for up to 18 women with complex and challenging mental health disorders.

We rated Milestones hospital requires improvement because;

  • Whilst the hospital described itself as a rehabilitation hospital, the type of patients the hospital admitted included those with other mental health conditions such as personality disorder or autistic spectrum disorder. Some patients were acutely unwell and required more intense support from staff than this type of service would usually offer. The service did not have a clear admissions policy therefore there was a large variety of patient needs for staff to meet.
  • The service had not mitigated all risks presented to patients and staff by the ward environment. We found blind spots and ligature anchor points in the ward environment which staff did not know how to manage.
  • The service did not deploy enough staff with the right skills and experience to manage the level of risk and the rehabilitation needs of all patients using the service. Staff we spoke with felt stress associated with being short of staff.
  • Staff had not received sufficient training, supervision or appraisal to do their job safely and effectively. Only 59% of staff overall had completed mandatory training and low numbers of staff had training in essential areas such as ligature training, electronic records training, intermediate life support training, the Mental Health Act and fire training. Only, thirty-five percent of staff had received an appraisal and 50% had received regular clinical supervision.
  • Staff did not always provide a recovery focussed rehabilitation service to all patients and the service did not measure outcomes for the treatments they offered. Staff focussed on managing the mental health conditions of some patients that they deemed high risk, so these patients were not offered a full rehabilitation based service.
  • Patients could not make their own hot drinks and snacks, they were dependent on staff to do this outside of certain times. Staff locked the kitchen for most of the day because they felt some patients were too high risk to be able to access the kitchen unsupervised. The provider addressed this immediately following the inspection.
  • Managers did not respond to complaints in a timely manner. Two patients told us they had made complaints and had needed to ask staff for a response. We reviewed three complaints and found two complaints where responses had taken a month or more.
  • Not all staff felt engaged in decisions about the service. Some did not feel listened to by managers when they raised concerns and the service’s whistleblowing policy did not make it clear who to speak to if staff felt uncomfortable raising concerns to the registered manager.
  • The provider did not have appropriate oversight of mandatory training, appraisal, supervision, and policies and procedures.

However;

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity and understood their individual needs. Staff supported patients to understand and manage their care, treatment or condition.
  • Staff involved patients in care planning, individual risk assessments and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. As a result, patients did not have excessive lengths of stay and discharge was rarely delayed for non clinical reasons.
  • The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.
  • Staff supported patients with activities outside the service, such as work, education and family relationships.
  • The service were aware of the needs of patients with a protected characteristic. Staff helped patients with communication, advocacy, and cultural and spiritual support.