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Archived: Brook House Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 26 and 27 July 2016

During a routine inspection

We rated Brook House as requires improvement because:

  • The hospital was not compliant with the Mental Health Act Code of Practice, published 2015. The required policies within the Code of Practice were not written and available. One prescription card had medication prescribed for a patient as required (PRN) which was not authorised on their T3 form. Staff had not received training in the revised Code of Practice. The responsible clinician frequently changed the days of the ward rounds at very short notice, meaning patients were not prepared for their meeting, the advocate was not present and if family or external professionals were due to attend they would not have been aware of the change.
  • Staff did not consider the Mental Capacity Act in their everyday practice. Capacity assessments were not taking place in accordance with the Mental Capacity Act and there was no consideration of best interest processes.
  • The hospital could compromise the safety of patients. The environmental risk assessment was not fit for purpose and did not identify the ligature points within the building or advise staff of how to mitigate the risks. The hospital manager was not following the ligature and self-harm policy. There was a sign on the clinic room door to inform staff that oxygen was stored there, however the oxygen was stored in the staff office. There was no emergency medication available for the overdose of benzodiazepines. The prescription cards were illegible. This posed a risk of staff administering the wrong medication to patients. There were no care plans in place for patients prescribed antipsychotic medication above the British National Formulary limits.
  • Staff did not receive the training relevant to their role. Mandatory training attendance levels were below 75% for the majority of courses, including emergency first aid and safeguarding adults. Staff did not receive training on the Human Rights Act. Specific training for the needs of the patients were low, including diabetes awareness at 21% and drug and alcohol awareness at 53%
  • The provider was not complying with the Duty of Candour Regulation. The policy did not specify that people should receive a written apology. Staff we spoke with were not aware of the duty of candour.
  • Care was not patient centred. Restrictive practices were in place including locking the cutlery away and not allowing detained patients to hold their own lighters. A patient had been deskilled, who was previously cooking independently and living in the annex. They had to move back into Brook House due to building works, had all meals cooked for them, and were in a hospital with locked doors. Care plans were nurse led and it was not clear what actions patients needed to take to progress from the service. Staff had not referred a patient identified as requiring psychology. There was no written information provided to patients upon admission to assist with orientation within the environment. Community meetings had a disproportionate amount of staff present compared to patients and actions from previous meetings were not always completed.
  • The hospital was not well led. There was no evidence of learning from incidents at a hospital or provider level. Policies at the hospital were all out of date, mainly from 2013. However, the provider had more recent versions in place, which the hospital had not made available to staff. Staff felt unable to progress within the organisation with limited opportunity for development including no opportunity to complete National Vocational Qualifications. There were no examples of staff surveys or any other methods or forums for staff to give feedback about the service.

However:

  • The hospital was homely and welcoming and provided the facilities to promote patients' recovery including access to drinks and snacks at all times and areas to spend in quiet. Patients had keys to their bedrooms and had their own mobile phones. The majority of patients had progressed within their time at Brook House and were pursuing activities in their local community independently. The occupational therapy assistant had created a plan to show times of activities available in the local community.
  • We observed warm, positive and nurturing interactions between staff and patients. All patients reported staff were friendly, caring and respectful. Patients had access to advocacy. Families were involved in ward rounds and care programme approach meetings if patients wished. Patients gave feedback about the service via service user questionnaires and community meetings.
  • The hospital manager was following the complaints policy and investigations were completed in a timely manner. Information was on display to inform patients how to complain.
  • Staff had appraisals and supervisions. Regular team meetings took place. Debriefs were taking place following incidents.
  • The provider’s recruitment and selection policy, dated July 2015, complied with the Health and Social Care Act 2008(Regulated activities) Regulations 2014 in relation to recruiting staff that are fit and proper.

Inspection carried out on 2 and 3 December 2014

During a routine inspection

There were a number of systems in place to check the health, safety and cleanliness of the building. Staff were aware of the individual risks to and from patients’ mental health needs and how the observation, support and monitoring of patients was used to manage risk within the environment. There were sufficient staff on duty to provide appropriate care and treatment to patients. There was good multi-disciplinary input for the size of the mental health hospital as the provider employed an occupational therapist and a social worker.

Patients told us that staff were approachable and they gave them appropriate care and support. We observed staff speaking with patients and providing care and support in a kind, calm, friendly and understanding manner. Patients were treated with dignity and respect. Patient’s relatives were complementary about the respectful care their loved ones received. There was a range of activities that patients could participate in. Information about the providers’ complaint procedure was clearly displayed on the hospital noticeboards. Patients told us that they felt well supported by staff in making complaints. There were some rules due to the nature of the locked rehabilitation role of the hospital. Managers of the hospital should clearly articulate the rationale for any local rule or restriction to both staff and patients through information and policy development.

Staff undertook training and had supervision, team meetings and appraisals to ensure they were competent and confident in their role. Patients were encouraged to give feedback on the quality of the service in various ways such as meetings and surveys. Information was analysed and action taken to maintain and sustain quality services. Regular audits were carried out by various levels of staff within the organisation. The audits themselves were of a good standard and issues identified within audits were usually addressed to improve the quality of services for patients. Whilst staff and managers were committed to providing quality services, it was not fully clear that audits and innovation were embedded within a co-ordinated clinical governance framework.

Brook House could have been more effective because care planning documentation did not always explicitly include sufficient written evidence of holistic individual discharge plans or provide evidence that ongoing baseline assessment and progress based on rehabilitation and recovery principles. The location had clear procedures in place regarding their use and implementation of the Mental Health Act and the Mental Health Act Code of Practice. However there were issues with section 17 leave recording, a lack of medical scrutiny of detention papers and staff did not have ready access to copies of detention papers at all times.

We did not identify any regulatory breaches on the inspection. We have asked the hospital to consider what they should do to improve services further in some areas.

Mental Health Act responsibilities

We do not rate responsibilities under the Mental Health Act 1983. We use our findings as a determiner in reaching an overall judgement about the Provider.

We carried out routine Mental Health Act monitoring visit in September 2014. Where we found issues relating to the MHA on these monitoring visits, managers of Deepdene Care provided an action statement telling us how they would improve adherence to the MHA and MHA Code of Practice. On this inspection we saw that many of the issues raised had been addressed, for example improved advocacy access had been arranged and the section 17 leave proforma had been amended to ensure patients received a copy.

The hospital had a Mental Health Act administrator who ensured that the responsibilities of the Mental Health Act were met. There were good systems in place to support adherence to the Mental Health Act. The records we saw relating to the Act were generally well kept. The exceptions were:

  • the recording of section 17 leave including section 17 leave forms being amended numerous times. The parameters of section 17 leave were also recorded on specific days of the week which did not permit flexibility.
  • Staff on the unit did not have access to detention papers out of hours.
  • There was no evidence of medical scrutiny of detention papers.

We found that staff at this location were aware of their duties under the Mental Health Act (1983). Staff had received relevant mandatory training.

Mental Capacity Act and Deprivation of Liberty Safeguards

Most staff spoken with demonstrated an awareness of the Mental Capacity Act. All but one of the patients at Brook House was detained under the Mental Health Act (MHA) and treatment decisions for mental disorder were therefore made under the legal framework of the MHA. We saw that patients’ mental capacity to consent to their care and treatment had been assessed as required under the MHA. Staff understood the limitations of the MHA, for example that capacity assessments were decision specific and the MHA could not be used for treatment decisions for physical health issues. The one informal patient on the unit had consented to stay on the unit and was living in the annexe. This person had a high degree of autonomy, including being able to leave the hospital without any significant restrictions.

Deepdene Care had a policy and a checklist for the consideration of Deprivation of Liberty Safeguards (DoLS). The checklist supported staff to consider whether a person was being deprived of their liberty – managers may wish to review this checklist in light of the recent case law (for example, the Cheshire West case). There was non-one subject to DoLS.

Inspection carried out on 6 June 2013

During a routine inspection

We found that patients at Brook House had complex mental health needs including severe and enduring mental illnesses, challenging behaviour and drug or alcohol dependency.

Brook House patients were supported by a multi-disciplinary team including a consultant psychiatrist and a consultant physician, registered mental health nurses, social worker, occupational therapist and experienced care support workers.

Brook House was able to facilitate the progression of patients into the community with the provision of an attached supported community housing annex that enabled individuals to prepare for independent living at a supported pace that was determined by them.

We found well maintained person centred care records including appropriate up to date documentation for the detention of the patients under the Mental Health act 1983.

We found the service had processes in place for cooperating with other providers including the local police force.

We found that staff were appropriately recruited with all pre employment checks being carried out in a timely manner.

Brook House had systems in place to assess and monitor quality within the service.

We spoke to three members of staff and found their experiences with the service were very positive. "I am a bank worker and love my job here it is a great place to work".

Only one patient agreed to speak to us during the inspection and he gave us positive feedback in the service.