The Care Quality Commission
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Archived: Eldertree Lodge

Overall: Inadequate read more about inspection ratings

Elder Tree Lane, Ashley, Market Drayton, TF9 4LX (01630) 673800

Provided and run by:
Coveberry Limited

All Inspections

24 June 2021

During an inspection looking at part of the service

About the service

Eldertree Lodge is an independent hospital and as part of their registration with the Care Quality Commission they also operate a supported living service called Oakwood House. Oakwood House provides personal care to seven people with learning disabilities, autism and/or mental health needs, who want to live in the community. People living at Oakwood House have a tenancy agreement in place for their accommodation.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Risks to people’s safety were assessed but the actions needed to keep people safe were not always present. Legal authorisations for the use of restricitve practice were missing and guidance was not always clear about what people could or could not do. This meant people were at risk of being unlawfully restricted. Accident and incident forms were not always reviewed although plans were underway to ensure this happened.

The provider did not carry out the necessary checks made to visitors, because of the COVID-19 pandemic, and staff did not always wear their face masks, as directed in the guidance.

The governance systems in place had not been effective at monitoring people’s care. There had been a lack of oversight from the provider which meant a care plans had not been updated and some staff had felt forgotten. The provider acknowledged this and shared their action plan for making improvments and who was going to be responsible.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: Oakwood House was set up with the support of local commissioners and offers people bespoke packages of care in the community. However, amendments were needed to people’s care plans to demonstrate how people were being enabled to have maximum choice and control over their lives.

Right care: People did have a personalised package of care. However, the provider was not yet able to demonstrate how they were ensuring people’s human rights were maintained alongside a number of restrictive practices being in place.

Right culture: The service had recently gone through several changes, including a change of leadership. More time will be required to assess whether the leadership in place ensures people have inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The regulated activity of personal care being provided at Oakwood House is part of the registration of Eldertree Lodge. Eldertree Lodge has recently been inspected and is rated as Inadequate. Please see our website for the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was carried out following concerns raised at Eldertree Lodge. We undertook this targeted inspection to review how risk was being managed and the effectiveness of the governance systems in place. We also looked at infection prevention and control measures under the safe key question. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

Enforcement action has not been proposed for Oakwood House. However, enforcement action was taken following our inspection of Eldertree Lodge. Please see our website for the full report which is on our CQC website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

20 May 2021 to 3 June 2021

During an inspection looking at part of the service

Eldertree Lodge is an independent mental health hospital provided by Coveberry Limited. It is a 41-bed hospital providing specialist inpatient treatment and longer-term high dependency rehabilitation services for adults aged 18 years and over in locked wards specifically for patients with a learning disability or autism. Coveberry Limited also provide a supported living service, Oakwood House, through the registration of personal care at Eldertree Lodge. Oakwood House was not visited as part of this inspection. An inspection of Oakwood House is planned and upon completion the inspection report will be available on our website www.cqc.org.uk.

On 23 and 25 March 2021, we completed an unannounced, focused inspection of Eldertree Lodge in response to information of concern about the care and treatment provided there.

Following the inspection, we served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within 24 hours that described how it was addressing our concerns. Their response did not provide enough assurance they had acted to address immediate concerns.

Due to the serious nature of the concerns we found during this inspection, we used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and imposed additional conditions on the provider’s registration. This included a condition to restrict the provider from admitting any new patients to Eldertree Lodge without the prior written agreement of the Care Quality Commission.

This inspection rated Eldertree Lodge inadequate and placed it into special measures.

You can read our findings from our all of our previous inspections by selecting the ‘all reports’ link for Eldertree Lodge on our website at www.cqc.org.uk.

This inspection which commenced on 20 May 2021 was an unannounced, focussed inspection to see what improvements the provider had made. Our inspection focussed on the concerns we raised to the provider following our previous inspection.

Following the 20 May 2021 site visit, we issued the provider with a requirement to provide documentation and closed circuit television recordings specific to high level incidents of restraint and incidents where a patient had made an allegation against a member of staff causing harm. We made this request because we identified concerns about the use of restraint with patients. The requirement was issued under Section 64 of the Health and Social Care Act 2008.

On receipt of this information, we carried out a further unannounced site visit on 3 June 2021. During this visit we reviewed closed circuit television camera footage from six incidents specific to one ward from 27 February 2021 to 13 April 2021. We also looked at closed circuit television camera footage from eight incidents that occurred between 6 May 2021 and 14 May 2021. These incidents were randomly sampled from Ash, Chestnut and Birch wards.

Due to the seriousness of the concerns we identified during this inspection, we sent a letter to the provider detailing our concerns and giving them opportunity to provide documentary evidence that risks were being managed, and patients were safe. However, the provider’s response did not fully address all areas of our concerns. We sent a further letter setting out our concerns and giving the provider another opportunity to provide assurances through documentary evidence. Again, the provider’s response failed to address all areas of our concerns, provide adequate detail of risk management and assure us patients remained safe at the service.

On 14 June 2021, we sent the provider an urgent Notice of Decision detailing our decision to vary the provider’s conditions of registration to remove regulated activities at Eldertree Lodge. The variation removed inpatient treatment and high-dependency rehabilitation services at Eldertree Lodge from 17 July 2021. The notice also detailed conditions on the provider’s registration to ensure the removal of regulated activities was managed in a safe way for patients.

We made this decision because:

  • We believed patients continued to be exposed to a risk of harm. Staff actions or omissions in care did not always protect patients from avoidable harm. Closed circuit television camera footage showed staff ill treatment and abuse of patients.
  • Staff did not always manage incidents and behaviours that challenge well. Closed circuit television camera footage showed staff sometimes used inappropriate restrictive techniques with patients and behaved unprofessionally during incidents.
  • Staff did not always safeguard patients from abuse. Staff failed to identify, record and notify actions or omissions in care that exposed patients to the risk of harm.
  • We were not assured the provider always referred staff to registered bodies for further investigation following incidents of concern.
  • Governance processes did not always work well. The provider’s improvement plan did not demonstrate sufficient improvements. The provider’s response to concerns raised to them did not provide assurance patients would remain safe from avoidable harm.
  • Staff continued to not always use correct infection prevention and control measures to keep patients and staff safe. Staff continued to not always follow national COVID-19 guidance.
  • We found a continuation that not all ward areas were clean, safe and well maintained. Many ward areas continued to have increased risks of slips and falls, ripped or broken furniture and damaged paintwork, and maintenance work had not always been completed to a good standard.
  • We continued to find out of date food in ward kitchen areas.
  • The provider continued to rely on temporary staff to maintain safe staffing of the hospital. The hospital did not always have enough appropriately skilled and experienced staff to ensure patient’s needs were identified and met.
  • The provider did not always make notifications to external bodies. Staff did not always record enough detail of the incidents and concerns they notified to external bodies.
  • Staff did not treat patients with compassion and kindness. They did not respect patient’s privacy and dignity. Not all staff understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Leaders did not have a good understanding of the services they managed and were not always visible in the service and approachable for patients and staff. Although the provider had introduced ward manager roles the impact of these roles was not seen.

23 March and 25 March 2021

During an inspection looking at part of the service

Eldertree Lodge is an independent mental health hospital provided by Coveberry (Caretech). Coveberry (Caretech) registered as the provider of services in November 2020 following the acquisition of the location from another provider. It is a 41-bed hospital providing specialist inpatient treatment and longer-term high dependency rehabilitation services for adults aged 18 years and over in locked wards specifically for patients with a learning disability or autism.

We undertook this unannounced, focused inspection because we had concerns about the care and treatment provided at Eldertree Lodge through information and intelligence.

Following the inspection, we served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within 24 hours that described how it was addressing our concerns. Their response did not provide enough assurance they had acted to address immediate concerns.

Due to the serious nature of the concerns we found during this inspection, we used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and imposed additional conditions on the provider’s registration. This included a condition to restrict the provider from admitting any new patients to Eldertree Lodge without the prior written agreement of the Care Quality Commission.

We did not look at all key lines of enquiry during this inspection. However, the information we gathered, the significance of the concerns and clear impact on patients provided enough information to make a judgement about the quality of care and to re-rate the provider.

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

  • The ward environments were not safe and clean. Staff did not always adhere to COVID-19 national guidance, putting staff and patients at risk. Not all staff were trained in the same restrictive techniques to ensure patients remained safe.
  • The wards did not always have enough nurses with the right skills, experience and patient knowledge. Staff did not always engage well with patients and put patients at risk by not always following treatment plans due to their lack of knowledge of the patients.
  • Risk to patients was not always managed well. Incidents were not investigated thoroughly, and associated learning was not adequately shared amongst staff.
  • Not all staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging. Staff were slow to deploy de-escalation techniques to prevent patients’ further distress.
  • Not all patients were treated with dignity and respect. Patients were not always happy with the care and treatment provided.
  • Governance processes did not always operate effectively at ward level and performance and risk were not managed well. Managers told us they were working to rectify several concerns since they took over the service, but many identified and unidentified issues remained.
  • Leadership was poor and staff did not always feel supported, valued or respected by senior leaders.

However:

  • The ward teams had access to a range of specialists required to meet the needs of patients on the wards, apart from a speech and language therapist. Care plans reflected patient needs and were holistic.
  • Carers and families were complimentary about the service and staff communicated well with them.

The Chief Inspector of Hospitals is placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.