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Inspection Summary


Overall summary & rating

Good

Updated 11 December 2019

Our rating of this service improved

. We rated it as good

because:

  • The service provided safe care for patients with neurological mental health conditions. 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 and followed good practice with respect to safeguarding.
  • Staff developed holistic care plans. They provided a range of treatments suitable to the needs of the patients cared for and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • 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.

However:

  • When staff carried out observations they continued to use pre-printed record sheets which meant they did not record an accurate time for their observation.
  • Staff did not consistently monitor patient’s physical health as they should have done, record their actions and did not always act when patients’ physical health had deteriorated. We saw that cupboards on Maltby ward where medicines were stored were not clean. Staff had used out of date medical supplies and had not acted when the fridge temperature had increased above safe levels.
  • Although some activities were taking place, which was an improvement from our last inspection, staff did not always accurately record whether patients were engaged in therapeutic activities.
Inspection areas

Safe

Good

Updated 11 December 2019

Our rating of this service improved. We rated it as good because:

  • All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose for patients with neurological mental health conditions.
  • The service had enough nursing and medical staff, who knew the patients and who had received training to keep patients safe from avoidable harm.
  • 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. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint and seclusion only after attempts at de-escalation had failed.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service used systems and processes to safely prescribe, administer and record medicines. Staff regularly reviewed the effects of medicines on each patient’s physical health.
  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • When staff carried out observations they continued to use pre-printed record sheets  and did not record the actual time of their observation. This meant records were not accurate.
  • We saw that cupboards on Maltby ward where medicines were stored were not clean and that that staff were using out of date syringes.
  • Staff had not acted when the fridge temperature had increased, this could impact on the efficacy of medicine.

Effective

Requires improvement

Updated 11 December 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Staff did not consistently carry out observations of patient’s physical health and did not always respond to these in line with guidance on addressing deterioration in physical health. Although there had been some improvement from our last inspection this remained an area of risk.
  • Although some activities were taking place, which was an improvement from our last inspection, staff did not always accurately record whether patients were engaged in therapeutic activities, staff recorded patients sleeping and resting on these sheets which was not an activity.

However:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were personalised and holistic.
  • Staff provided a range of care and treatment interventions suitable for the patient group to support self-care and activity that supported activity.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.
  • The ward teams included or had access to staff required to meet the needs of patients on the ward. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The ward teams had effective working relationships with other staff from services that would provide aftercare following the patient’s discharge and engaged with them early in the patient’s admission to plan discharge.

Caring

Good

Updated 11 December 2019

Our rating of the service stayed the same. We rated this as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Staff involved patients in care planning and risk assessment and sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • Staff informed and involved families and carers appropriately.

Responsive

Good

Updated 11 December 2019

Our rating of this service improved. We rated it as good because:

  • 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 other than a clinical reason.
  • The design, layout, and furnishings of the ward/service 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.
  • The food was of a good quality and patients could make hot drinks and snacks at any time.
  • The wards met the needs of all patients who used the service – including those with a protected characteristic. Staff helped patients with communication and advocacy.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

Well-led

Good

Updated 11 December 2019

Our rating of this service improved. We rated it as good because:

  • 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.
  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Staff felt respected, supported and valued. They felt able to raise concerns without fear of retribution. They were confident in the hospital leaders.Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.
  • Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 11 December 2019

Other CQC inspections of services

Community & mental health inspection reports for Forest Hospital can be found at Barchester Healthcare Homes Limited.