The Care Quality Commission
  • Mental Health
  • Independent mental health service

Magna House

Overall: Good read more about inspection ratings

Main Road, Anwick, Sleaford, Lincolnshire, NG34 9SJ (01526) 809771

Provided and run by:
Enbridge Healthcare Limited

Important: We are carrying out a review of quality at Magna House. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

18 October 2023

During a routine inspection

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

  • The hospital was clean and well maintained. Cleaning records were up to date and the wards were bright, airy, well-furnished, and fit for purpose. The hospital had a dedicated maintenance team, we saw all staff had access to an electronic log, where issues were prioritised, actioned in a timely manner and signed off on completion.
  • Staff completed risk assessments for each patient on admission, using a recognised tool, and reviewed this regularly, including after any incident. Staff documented the individual risks for each patient and acted to prevent or reduce them. Staff we spoke were aware of what strategies to use to minimise and manage risks and how to support individuals when they posed a risk to themselves, others, or their environment. Accurate risk information was handed over and recorded in the morning management meeting.
  • Staff followed National Institute for Health and Care Excellence (NICE) guidance when using rapid tranquilisation. They ensured it was recorded in the care record and an incident form completed. The hospital incident reporting system would not allow the incident to be closed unless all physical health checks had been completed and recorded appropriately.
  • Staff completed a comprehensive assessment of each patient either on admission or soon after. We looked at six care records, all of which reflected patients’ assessed needs and were holistic and recovery oriented.
  • Managers supported staff with appraisals, supervision, and opportunities to update and further develop their skills. Staff supervision and appraisal rates were 100%. They identified any training needs and gave staff the time and opportunity to develop their skills and knowledge. Staff received specialist training for their role, for example Oliver Mc Gowan training, diabetes, oral health and learning disability. Staff told us managers were supporting them to undertake a master’s degree.
  • We saw “you said - we did” boards on all wards. Patients had provided feedback and suggestions which they recorded on the boards. Managers had acted upon feedback for example; we saw white boards had been installed in bedrooms where patients could write down the name of their nurse, and more evening activities had been planned and a new washer/dryer had been purchased.
  • We saw staff involved patients in decisions about the service, when appropriate for example suggestions on the décor, menu choice and therapeutic activities. Staff and patients attended weekly community meetings where topics discussed included the environment, meals, patient involvement opportunities, achievements and celebrations and staying connected with family and friends.
  • Leaders were visible and approachable, not only to them but for patients too. Staff told us leaders often visited the wards and would work shifts to support the team and were always available whenever for whatever they needed. They confirmed development opportunities for career progression were available and were encouraged to take these up.

However:

  • Staff used a range of rooms and equipment to support treatment and care, however there was no dedicated spaces for therapeutic activities which were undertaken in dining and lounge areas.
  • We found left over medicines from a patient who had been discharged in cupboards on two wards. We brought this to the attention of the nurse in charge who disposed of the medicines immediately.
  • We were concerned that governance systems and processes were not sufficiently embedded so that when the patient numbers and acuity increase, they remain effective to support the operational performance of the service.

26 April 2023 & 27 April 2023

During an inspection looking at part of the service

Our rating of this location went down. We rated it as inadequate because:

  • Staff did not consistently record and report incidents in line with the provider’s policy. Staff had not reported some incidents, including a small fire at the service, and the partial collapse of a bedroom floor.
  • The service had failed to notify CQC of some reportable incidents involving the Police.
  • Some patients told us they had experienced physical assaults by staff.
  • The hospital was not clean. Some patient bedrooms were cluttered with personal belongings, food, drinks, dirty crockery and rubbish.
  • The provider had failed to address maintenance issues and repairs in a timely way, leaving areas of risk to some patients, including ligature risks.
  • Staff had not followed best practice following administration of rapid tranquillisation with the monitoring and recording of physical observations in care records.
  • There were not enough registered mental health nurses on shift across the hospital to consistently meet the needs of the patients in a safe and timely way.
  • Not all staff had been trained or updated with training around the management of violence and aggression.
  • There had been a high number of patient assaults on staff. Staff we spoke with had been left unsupported following such incidents.
  • Staff had not updated individual patients risk assessments following incidents to reflect current risks and management of these risks.
  • Not all staff adhered to the providers infection prevention and control policy.
  • Staff did not adhere to the Mental Health Code of Practice (CoP) during an incident of seclusion.
  • Patients told us that not all staff treated them with kindness and compassion. Some patients told us that staff did not always interact with patients while they were on enhanced observations. We heard of occasions when staff had been speaking to one another in front of the patients, in a language other than English.

However:

  • Staff told us that staffing overall had improved over recent months.
  • All staff we spoke with told us that the hospital director and deputy hospital director were visible across the service, and accessible.
  • Some patients and carers we spoke with were positive about some of the staff team.
  • The provider kept an updated log of all safeguarding concerns reported to the Local Authority with commentary on actions taken or outstanding.

04 and 05 October 2022

During a routine inspection

Our rating of this location went down. We rated it as requires improvement because:

  • We found that patients were not as involved as they could be with care planning and care plans were not always patient centred and recovery focused. In addition, discharge planning was not evident in the patient care plans we viewed.
  • Staff did not update risk assessments after every incident, nor did they follow best practice after administering rapid tranquillisation with the monitoring and recording of physical observations in care records.
  • We observed and patients and staff told us there was a lack of therapeutic activities.
  • There were not enough registered mental health nurses on shift across the cottages to consistently meet the needs of the patients in a timely way.
  • Some patients told us that staff were not always polite or kind and there were language barriers due to the number of nurses whose English was not their first language.
  • We collated evidence that the ward environments were dirty and in need of repair. Two patient bedrooms viewed were untidy and cluttered with various personal items, including food and drinks.
  • Whilst we found that governance systems were in place, they had not been effectively used to monitor the provisions of services provided and to make improvements.
  • During 2022, three patients had been transferred to other units due to having more acute needs.

However,

  • Staff completed risk assessments of all ward areas, including ligature anchor points and carried out observations safely.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Managers ensured that staff received supervision and an annual appraisal. Staff were up to date with mandatory training and had access to specialised training to support their roles.
  • There were systems and processes to prescribe and administer medicines safely. Staff reviewed each patient’s medicines regularly in ward round and staff completed medicine records accurately.
  • Patients had access to advocacy on an individual basis and within community meetings.
  • The service treated concerns and complaints seriously, which they investigated and identified themes and trends to improve patients experience.

16 May 2022

During an inspection looking at part of the service

Magna House is a 29-bed independent hospital in Lincolnshire, providing care, treatment and rehabilitation services to people who are experiencing mental health issues

This was a focussed unannounced inspection of one ward in the hospital that was not open at the time of the inspection and therefore had no patients. We did not re-rate the service at this inspection due to the narrow focus of the inspection activity.

The purpose of this inspection was to see if the provider had met the requirements of the conditions imposed on their registration in August 2021, in respect of Redwood ward. In August 2021 the provider was told they had to address the issues we found at our inspection in July 2021, and meet the conditions imposed on their registration before they could re-open and admit new patients to Redwood ward.

We found the service had met the requirements of the conditions imposed on their registration in August 2021 as follows:

  • Redwood ward was clean throughout.
  • Managers had ensured the damaged flooring throughout the building had either been replaced or repaired.
  • Managers had replaced the broken windows and repaired the wooden cladding on the side of a building in the garden.
  • Managers had ensured the air conditioning unit in the conservatory had been repaired and was connected to a thermometer that automatically adjusted the temperature in the conservatory, so it did not become too hot or too cold.
  • Managers had treated the insect infestation found at the last inspection. There was no evidence of further insect infestation on the ward specifically on the corridor leading to, or in the conservatory.
  • Managers had completed a full environmental risk assessment of Redwood ward. Managers had mitigated against the risks posed by blind spots and potential ligature points on the stairwell, bannister rails and door closures.
  • All staff, including those who would be working on Redwood ward, had completed fire training and fire evacuation training. Managers provided evidence of regular fire drills and lessons learned from each drill to improve their effectiveness and speed.
  • Managers had installed call alarms in all patient bedrooms. Staff had effective emergency alarms and the provider had testing protocols for the alarms.
  • Managers had ensured that all external doors were secure and replaced door locks where required.
  • All the bedrooms on Redwood ward, had fully working showers and hand basins. Safety mirrors were in place in all ensuite bathrooms.

27 July 2021

During a routine inspection

Redwood Ward was visibly dirty, we found high- and low-level dust, in stairwells and corridors. We found a significant insect infestation at the entrance from the indoor corridor to the conservatory, which was the main lounge of the ward.

The ward had multiple blind spots that were not mitigated by the use of mirrors.

Two staff we spoke with were not aware of what to do in the event of a fire.

Managers had not ensured staff and patient safety; patient and staff alarms were ineffective and staff did not respond when both patient and staff alarms were activated.

Managers had not ensured security within the ward area, we found the main door to exit the ward was unlocked and patients could easily leave the ward without the required permissions.

Managers failed to ensure that patients on Redwood Ward had access to working showers in their ensuite bathroom or safety mirrors to attend their personal hygiene. Staff told us they provided handheld glass mirrors which they would hold up to support patients to shave, this compromised their dignity and privacy. We checked all 11 showers on the ward to see if they were in working order. Only four had fully functioning showers. Two patients on the ward were in bedrooms that did not have a working shower. Evidence provided after the inspection demonstrated the showers were subsequently fixed.

Managers had failed to ensure staff and patient safety on Redwood Ward. Staff could not tell the inspection team how they would respond if they identified a fire on the ward. Neither staff member could tell us where the fire point alarms were. We were concerned that if a fire did break out staff did not have the right level of awareness or training of how to raise the alarm to keep service users and other staff members safe.

Due to the substantial concerns we found during the inspection we instructed the provider to relocate patients from Redwood Ward to another ward in the hospital. This was done immediately.

1 june

During a routine inspection

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. Mandatory training compliance was 92%, which included safeguarding, positive behaviour support and food safety.

The service had enough nursing and support staff to keep patients safe. The service had reducing vacancy rates. There were no qualified nursing vacancies and four healthcare support worker vacancies. There was an active ongoing recruitment campaign in place. Levels of sickness were low at 2%.

Patient care plans and risk assessments were comprehensive, and staff could access them easily. When patients have section 17 leave within a specific geographical area such as a 10-mile radius of the hospital, a map is downloaded and placed in the patients clinical notes alongside the S17 form to ensure they are fully informed of the parameters of their leave.

The ward teams included the full range of specialists required to meet the needs of patients on the wards. Managers made sure they had staff with the range of skills needed to provide high quality care. Managers supported staff with appraisals, supervision and opportunities to update and further develop their skills. Staff appraisal rates were 100% and clinical supervision rates were 84%. Managers provided an induction programme for new staff and mentoring opportunities for all new starters for the first six months of their employment.

We spoke with six patients and four carers during the inspection, their feedback was overwhelmingly positive, two patients said that Magna House was the best hospital they had ever been admitted to. They said the staff were very kind and took them out in the hospital car to go shopping and on trips.

Staff introduced patients to the ward and the services as part of their admission and gave them a comprehensive welcome pack, which was available in a variety of formats where appropriate. Staff involved patients in decisions about the service, when appropriate for example suggestions on the décor and menu choice. Staff supported patients to make decisions on their care for example supporting them to cater for themselves and devise individualised therapeutic programmes.

Staff told us they felt respected, supported and valued. They said the provider promoted equality and diversity in daily work and provided opportunities for development and career progression and they felt proud to work at Magna House. They could raise any concerns without fear and said that they were actively to speak up if they felt they need to raise an issue.

However:

Not all ward areas were clean, we saw evidence of high and low-level dust and one bedroom was visibly dirty and had a distinctive odour of urine. The dining room had stained walls and we saw ant activity within patient areas. We brought this to the attention of the hospital managers, and it was rectified immediately.

Staff could not observe patients in all parts of the wards. Not all bedroom doors had vision panels, nine out of the 11 bedrooms we looked at had “peepholes” in situ, both inspectors attempted to look through the peepholes but were unable to see into the patient bedrooms.

Four out of the seven care records we looked at did not contain a completed Personal Emergency Evacuation Plan.

Patients did not have access information about independent mental health advocacy.