17 July 2020
During an inspection looking at part of the service
Duncan House was operated by Bridges Healthcare (PDU) Ltd. The service was a short stay, 30 bedded planned discharge unit operated by registered nurses, health care assistants, a therapy team and a visiting GP. The service offered short term stays of about one month for medically fit patients awaiting placement or next move following an admission to an acute hospital.
The service had a registered manager registered with the Care Quality Commission (CQC) in place and the registered manager was also the director of Bridges Healthcare (PDU) Ltd. The service registered as Duncan House on 31 March 2020, after a change of legal entity. Due to a need for hospital beds because of the COVID-19 crisis, local health commissioners had plans to transfer patients from a local acute hospital to Duncan House. At registration with the CQC on 31 March 2020, the registration had a condition placed on it. The condition was that Duncan House should provide the regulated activity treatment of disease, disorder or injury, to people who were referred by NHS Greenwich Clinical Commissioning Group or NHS Bexley Clinical Commissioning Group, for patients from the boroughs of Greenwich and Bexley only. As of 1 April 2020, Greenwich and Bexley CCG’s became part of South East London Clinical Commissioning Group (SELCCG).
Also, the local clinical commissioning groups provided additional assurance to ensure quality and safety on this unit was achieved. This included providing a task force to provide clinical oversight and leadership to Duncan House and that the service did not exceed 30 bed capacity. The task force had staff specialising in medicines management, safeguarding, nursing and governance who provided support into the service.
This was the first inspection since registration in March 2020. We inspected the service as we had concerns about the safety and leadership of the service. We inspected aspects of the safe, effective and well-led key questions. We carried out the focused announced visit to Duncan House and held virtual staff interviews on 17 July 2020. As this was not a comprehensive inspection, we rated the key questions of safe, effective and well-led as breaches of regulations limited the key question ratings, but did not give an overall rating to the location.
The Clinical Commissioning Group made a decision to withdraw commissioning arrangements with the provider as of 31 July 2020. Following this inspection the provider cancelled the registration for the location and the registered manager. The service has now closed an de-registered with the CQC on 7 August 2020.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
Our findings from this inspection were:
•The registered manager had a limited understanding and oversight of governance in the service to ensure operation of effective systems and processes to assess and monitor the service effectively.
•The registered manager had worked with commissioners of the service to introduce and review governance processes, when the service was registered in March 2020. However, the registered manager did not take action on the issues raised.
•The registered manager was unable to provide a comprehensive answer of what the expectation was for staff supervision, yet was responsible for providing supervision for registered nurses. This meant that there was a risk of staff missing opportunities to develop skills, identify solutions to problems, learn from incidents and improve standards of patient care.
•Not all registered nurses employed by the service had received supervision from a suitably qualified professional. This meant that there was a risk that staff were not appropriately skilled and competent to improve standards of care.
•The service had an insufficient governance policy that did not clearly define the service assurance processes. This meant that staff did not have adequate principles to guide their decisions.
•The service risk register did not include the risks posed by COVID-19 during the national pandemic.
•The registered manager had not ensured that staff in the service had a formal risk assessment or formally recognised the disproportionate impact of COVID-19 on Black Asian Minority Ethnic (BAME) staff and staff who were vulnerable and in an at-risk group. As a result, staff may have been subject to risks without adequate mitigation.
•Not all staff knew how to make a safeguarding referral to the local authority. This meant that raising safeguarding concerns could be delayed if the registered manager was not on shift and immediately available.
•Staff did not complete comprehensive incident forms consistently.
•Staff did not record discussions and learning from incidents. Staff were reliant on verbal handovers of information and could not confirm what action had to be taken to support individuals and mitigate risk.
However:
•The service provided mandatory training in key skills to all staff and made sure everyone completed it.
•Staff adhered to infection control principles. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.