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Reports


Inspection carried out on 27 to 30 November 2017

During a routine inspection

We rated Three Valleys Hospital as good because:

  • Safety was a high priority for the service and the measurement and monitoring of safety was a robust and continual process of improvement. Patients had detailed and thorough risk assessments in place which staff updated regularly. There were clearly defined and embedded systems and processes in place to keep patients safe and safeguard them from abuse. People received their medicines as prescribed and medications and equipment were stored safely. When incidents occurred staff recorded them well, investigated them appropriately and they utilised the learning of lessons to ensure improvements in safety.
  • Staff planned and delivered care and treatment to patients in line with national best practice guidance. A clinical improvement schedule was in place to monitor practice and ensure improvements were made. Where audits identified a need for improvement we saw that staff made changes. Patients had comprehensive and holistic assessments of the entirety of their needs and the service gave high priority to the monitoring of patient’s physical healthcare needs. Staff used legislation such as the Mental Health Act and Mental Capacity Act appropriately and monitoring systems were in place to measure and improve their use. The service supported staff to deliver effective care and treatment by providing them with supervision, appraisal and opportunities for reflective practice. The service had a strong multi-disciplinary team who worked together to produce holistic care and treatment plans for patients.
  • Feedback from patients and carers was positive about the why staff treated people. We observed care that was kind and compassionate and saw that staff knew the patient group well. Patients on the rehabilitation wards were encouraged to become active partners in their own care and in the running of the service. In the rehabilitation services staff used a variety of ways to encourage patients to give feedback about their care and treatment. In the specialist dementia service we saw examples of exceptional care where staff had gone the extra mile to provide comfort and care to patients.

  • The service was responsive to the individual needs of patients and made reasonable adjustments for patients with specific needs. People had discharge and recovery plans in place to support effective discharge and the service was focussing on a renewed focus for discharging patients more quickly where it was appropriate to do so. The service needed to continue to ensure this focus was embedded to enable us to see sustained improvement in the discharge of patients from the hospital. Patients on the rehabilitation wards were not restricted and staff gave them opportunities to enhance their skills for independence. Patients on all wards were able to access a variety of activities, which were planned to meet their individual needs, interests and support their recovery plans.

  • The service was well led. The senior leadership team were experienced and qualified and had robust governance systems in place to manage, monitor and maintain the safety of the service. The service had a clear statement of its vision, values and its strategy for the future. Senior leaders were aware of the challenges faced by the service and had implemented plans to meet these challenges and prevent them from having an impact on the care and treatment of patients. The leadership team modelled the culture of the service which was one of openness and transparency. They embedded least restrictive practice for patients and a sustained focus on driving improvement by learning lessons from incidents and complaints. There was a clear pathway from ward level governance to organisation wide governance and a clear system for reporting from ward to board and back to the staff teams. Staff told us that their managers were approachable and that morale within the service was increasing. The management team had responded quickly to staff morale concerns on Oakwroth ward and made significant improvements.

However,

  • The service was not always able to provide facilities which promoted the comfort, dignity and privacy of patients. However, the hospital director explained that the service was due to start a period of renovation which the provider supported and that these renovation plans would address all of these concerns within the next twelve months. Work had already begun on the replacement of doors on Oldfield ward.
  • The service did not always follow best practice guidance in relation to the use of do not attempt cardio pulmonary resuscitation forms on Oakworth ward. They were also unable to provide adequate psychological therapy services due to an ongoing vacant post for a qualified psychologist. Staff used a risk assessment tool which did not meet the needs of the patient groups.
  • Patients in the specialist dementia service were not asked to give feedback about their care and it was difficult to ascertain how they and their families had been involved in the planning of their care. Oakworth ward was not discussed in the service’s admission leaflet and therefore specific information was not available to patients and their carers.
  • Although the service was safe we found that staff needed to make improvements in their recording. Particularly in relation to the planning of leave, and the recording of patient physical health observations. service needed to ensure that local and national policy in the provision of emergency drugs on site were clear to staff to reduce the risk of error.

Inspection carried out on To Be Confirmed

During an inspection to make sure that the improvements required had been made

We inspected the responsive domain only at The Priory Hospital Keighley. We reviewed the breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at the last Care Quality Commission on the 8th February 2016. This breach was in relation to patients on the rehabilitation wards not having person centred discharge plans and individualised discharge dates. We also reviewed the areas in our last inspection we told the provider they ‘should’ look to improve.

At this inspection we found that all patients on the rehabilitation wards had individual discharge plans which included an estimated date for discharge from the hospital. The care and treatment records showed that there was a holistic approach to recovery which included patients’ discharge planning

Following the last Care Quality Commission inspection on 8th February 2016, we also told the hospital that it should take additional actions to improve.

At this inspection all the actions we told the provider it should take had been completed, as follows:

  • The hospital had implemented audits to monitor the completion of post-dosage monitoring and developed an easily accessible guide for post medication observation for nursing staff.

  • Mental health documentation monitoring was included in the monthly manager’s audit of the clinic room.

  • Guidelines were developed for housekeeping duties, including staff responsibilities, which ensured that staff were working within their professional roles.

  • An additional room on Oakworth Ward had been built to store wheel chairs and hoists. They were no longer being stored in the lounge area.

  • A robust system had been implemented to ensure the prayer room was available for patients to use when required.

  • Staff were able to access the ‘Controlled Drug Register’ on the rehabilitation ward when required.

  • The care programme approach meeting minutes we reviewed reflected the continuation of care, the decisions were clearly recorded and the reason for them._

In addition during this inspection we found that:

  • Oakworth ward had a new sensory garden which created a stimulating environment for its patients. The garden was accessible for patients with reduced mobility to facilitate independent access.

  • The hospital had recruited an additional occupational therapist and activities and therapies were now provided at weekends, as well as during the week.

The provider listened to patients’ views and made changes to the service. Patient feedback was displayed in the format of “you said” “ we did” to show how the hospital responded to patient views. 

Inspection carried out on 08/02/2016

During a routine inspection

We rated The Priory Hospital Keighley as good because :

  • Patients were happy with the care they received at The Priory Keighley. They felt as though staff were supportive and listened to them. We saw meaningful interaction between staff and patients. Staff worked alongside families and carers and carers spoke positively about the hospital. An advocate attended the hospital twice weekly and patients knew how to access this service.
  • The hospital maintained safe staffing levels and had procedures in place for any shortfalls in staff. The hospital did not use any agency staff, and relied upon regular bank staff to cover shifts. Staff were positive about working at The Priory Keighley describing to inspectors how supporting their teams were. We saw effective multi-disciplinary working across the wards. The GP and an external pharmacist attended the hospital regularly to support patients in their care. The hospital employed a range of disciplines including nursing staff, occupational therapists and psychologists.
  • We found robust monitoring of physical health throughout the hospital. All patients’ physical health needs were embedded into their care plans and staff had appropriate care to facilitate those needs. Medication management throughout the hospital was overall strong. We saw examples of regular consultations with external pharmacy for support in various things, i.e. medication manipulation. The documentation around medication was clear and robust, patients had individualised care plans for their medication which was comprehensive and easy to understand.
  • We saw a range of therapeutic activities provided for patients. They had a daily activity planner which included weekends. The hospital provided two hours patient protected time. This meant all ward staff had two hours protected time with patients which enabled more face to face contact. The hospital had access to psychology, however, staff felt it wasn’t utilised by patients as effectively. Patients in the neurodegenerative ward had access to a sensory room. This room stimulated patients and supported them therapeutically.
  • Staff were up to date with their appraisals and had regular supervision. The hospital was undergoing a transition of implementing clinical supervision within their management supervision. Staff felt that clinical supervision was helpful. Staff were up to date with training, and support was provided to staff to progress within the organisation. The hospital staff told us that they tried to avoid using physical restraint and preferred to use verbal de-escalation techniques.
  • The hospital had updated its policy in line with the changes to the Mental Health Act code of practice. Staff understood the basic principles of the Mental Capacity Act. Staff carried out regular capacity assessments and held best interests meetings.

However,

  • We found not all post medical observations had been documented after a patient had been administered medication. This is when patients are monitored for side effects after taking medication.
  • We found a Mental Health T3 document had not been reviewed by a Second Opinion Authorised Doctor within the time given for it to be reviewed.
  • The prayer/multi-faith room was also utilised as a visitor’s room. We felt this restricted its use as a prayer room because it could not be accessed if patients had visitors.
  • We could not find the controls drug register in the clinic room where the controlled drugs are kept, however staff provided us with it once requested.