Archived: Blackshale House

We spoke with the manager, six staff of differing roles, and two people who used the service during our visit. There were ten people receiving care and treatment at the hospital at the time of our visit.

One person receiving support said “I think it’s really good”. “The regular staff have been great to me.”

We looked at the care records of three people who were using the service. Care plans in place but were not adequately detailed to provide safe care and manage risks, particularly regarding preventative action to take regarding self harm. There were not care plans in place to describe how people’s healthcare needs were to be met.

We had not planned to assess the management of medicines but did so as a medication error had occurred. We found there were not robust systems in place to manage stocks, disposal and administration of medicines.

Staffing levels at the hospital were insufficient to meet people’s needs. There was a high use of agency staff due to insufficient numbers of permanent staff. The manager and all staff we spoke with told us about their concerns around staffing levels. There were not systems in place to support and supervise staff. Inductions for agency staff were brief and did not ensure they were aware of the risk and needs people had.

There were 11 people in the hospital when we visited; nine of these people were detained under the Mental Health Act 1983.

We spoke with two people using the service and the manager and two staff during our visit. People told us that whilst there were usually staff around if they needed them the availability of staff was affected by the number of one to one observations that staff were required to do.

People were consulted about their care plans and their views were taken into account. Where care plans were in place they were well detailed but there were some identified needs people had where no care plans were available.

We found there were not robust systems in place to ensure that staffing levels were sufficient for the needs of people using the service. To maintain staffing numbers there was a reliance on agency staff and staff who were working outside of their usual role at the home. There were occasions where people's leave outside of the home had not taken place due to insufficient staffing.