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Shrewsbury Court Independent Hospital Good

The partners registered to provide this service have changed - see old profile

Reports


Inspection carried out on 10 November 2020

During a routine inspection

Shrewsbury Court is a small 50-bed independent hospital which provides long stay/rehabilitation mental health wards for working-age adults.

Our rating of Shrewsbury Court stayed the same. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. The service had put policies, procedures and additional cleaning in place to keep patients safe from Covid-19.
  • The full range of mental health disciplines provided input into each ward and patient care. Patients were assessed on arrival by occupational therapy and provided with regular 1:1s to support patients develop skills for their discharge. We saw evidence of patients’ physical health being monitored and the service employed a nurse who focussed on patients’ physical health.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. All staff interactions that we observed with patients were caring and respectful, and patients spoke positively about staff.
  • Patients did not have excessive lengths of stay and discharge was rarely delayed for other than a clinical reason. The service treated concerns and complaints seriously.
  • The service was well-led and their governance processes ensured that not only ward procedures ran smoothly, but also that the senior management team had good oversight, including monitoring and supporting ward managers, who had recently been devolved more power.

However,

  • The quality of care plans was variable across the wards. Some care plans were not updated or centrally stored on the electronic recording system, and didn’t always carry across risks identified at assessment, however, others we saw were holistic and patient focussed.
  • The rehabilitation activities provided were limited, not seven days a week and timetables consisted of mainly leisure activities.
  • There was variance in the recording of patient observations and on some wards we saw gaps in records.
  • Training, appraisal and supervision rates were variable for the last few months. Some wards had consistently high rates of supervision, whilst others didn’t. Appraisals across the hospital were low, the senior management team were aware of these issues and were taking action to improve these.
  • Patients who use the service told us that they felt involved in their care planning and understood their rights under the Mental Health Act. Patients told us that staff checked in with them after any patient incidents or aggression on the ward and that staff were supportive. However, some patients told us that they did not feel that they have meaningful activities to do, especially on evenings or weekends.

Inspection carried out on 15-17 May 2017

During a routine inspection

We rated Shrewsbury Court Independent Hospital as good because:’

  • Staff had completed monthly environmental assessments for all wards which included a comprehensive audit of potential ligature risks and had completed a programme of works to reduce or make-safe potential ligature points. Where these remained, a plan for mitigating these risks had been completed by staff and included as part of the audit.

  • Shifts were covered by sufficient qualified and experienced staff.

  • There was a qualified nurse on the ward area at all times. This was recorded on the daily shift planner. There were sufficient staff to safely carry out physical interventions and medical staff were available each day and on call at week-ends.

  • Staff were up to date with all mandatory training as evidenced in the staff training matrix.

  • All staff had completed safeguarding training and each ward had a named safeguarding lead.

  • Staff were monitoring patients’ physical health regularly, and all the wards had access to the practice nurse.

  • Medicine prescribing practices were audited weekly by the pharmacist.

  • Patients had access to individual and group psychology sessions.

  • All staff had regular clinical and management supervision.

  • Patients took part in a satisfaction survey in March 2017 with an 86% response rate, allowing the patients to have a voice and opinion on the hospital and their treatment.
  • The ward used key performance indicators to assess the quality of the care given, this included the provision of personalised activities, 1:1 time and use of section 17 leave.
  • Ward managers were the key decision makers for all ward based staff and they had access to administrative and managerial support when required.

Inspection carried out on 29 Aug to 1 Sept 2016 and 9 Dec 2016

During an inspection looking at part of the service

We did not rate this location as it was a focused inspection.

During our inspection in August 2016 we focused on the key areas of safe and well led out of the five domains that we inspect against and found a number of concerns. We visited the provider again in December 2016 and found that the provider had made a number of significant changes and improvements. Both inspections are described within this report.

When we undertook the inspection in August 2016, the areas that required improvement were as follows:

  • Risks caused by ligature points on the wards and outside spaces were not identified and mitigated.

  • No action had been taken to reduce the internal ligature risks identified at our previous inspection.

  • We had concerns regarding medication management. We found 15 medication errors in the 50 medication charts we reviewed.

  • The provider had received weekly pharmacy audits which identified medication errors. However, no action had been taken to address the issues identified.

  • Staff supervision was not followed in line with the organisational policy. Supervision meetings were very sporadic and inconsistent. Of the 24 personnel files we reviewed, we found five files which had no record of supervision meetings being carried out at all.

  • Mandatory training attendance was inconsistent. Training rates in the Mental Health Act, health and safety and risk management were all below the target of 75%.

  • The provider had up to date policies but there were few systems in place to ensure policies were complied with and processes were safe.

As a result of our serious concerns about the service we served two warning notices on the provider. We asked them to make urgent improvements to the service and take steps to protect clients from avoidable harm. The provider produced an action plan to address our concerns and kept us updated regarding the progress made.We returned to the service on 9 December 2016 for an unannounced follow up inspection to look at the specific concerns relating to the warning notices.

The provider had made many effective changes and it was evident that a lot of work had been carried out in order to make improvements to the service, most notably:

  • The wards all had ligature identification tools that were completed weekly. These tools linked with ligature risk assessment and management forms and stated the hazards, risk level and control measures in place.

  • All medication errors that had been identified in the previous inspection had been recified and measures had been put in place to prevent further reccurence.

  • Each ward now had a named responsible clinician which made patient care and communication more consistent.

  • We reviewed 20 personnel files and 16 files showed that staff had attended supervision meetings within the last month. The supervision template had been reviewed and was evidenced in the files and the policy had been reviewed and updated.

Inspection carried out on 11 - 13 August 2015

During a routine inspection

Inspection carried out on 1 August 2013

During a routine inspection

People told us that they were kept informed regarding their care and treatment and that they were able to attend daily meetings to discuss their daily activities.

One patient told us "the hospital is satisfactory considering my circumstances". Another patient told us "It is a terrible place to be". Two patients told us that they were making good progress and this was because the staff cared and gave them encouragement and support.

We saw that patients had care plans and were they were given copies of their plan. One patient told us that they did not wish to have a care plan as this was meaningless and a waste of time.

We had good comments regarding the food and were told that there was choice and variety. Some patients told us they participated in cooking activities that was part of their rehabilitation programme toward community living again.

Patients told us they knew their rights and they felt safe. They told us they were able to talk to their allocated nurse or any member of staff if they had a problem or concerns. Staff told us they had undertaken their safeguarding training and they would not hesitate to report any concerns or issues to their line manager.

We saw that the hospital was clean and cleaning schedules were in place that ensured communal areas, bathrooms and toilets were cleaned daily.

Staff felt they had the appropriate training to undertake their roles and responsibilities.