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Archived: Sevenacres (Inpatient Wards)

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All reports

Inspection report

Date of Inspection: 12 July 2011
Date of Publication: 5 September 2011
Inspection Report published 5 September 2011 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

Since our last visit, changes have been made in ensuring people receive safe and appropriate, personalised care. Systems are in place for assessment, planning and review of people’s physical and mental health care, and we saw evidence that people had been involved in planning their care.

We have a minor concern that there are still some inconsistencies in the documentation of care in people’s notes, and in some cases people may not have received the most effective care because of this. This had also been identified through the unit’s quality assurance processes, and action is being taken to address it.

On the basis of the evidence provided and the views of the people using the service, we found the service to be compliant with this outcome

User experience

We spoke to people on the wards, most of whom told us that the care they had received was good. One person said that the care varied between nurses, and that sometimes they had to wait for medication.

We spoke to one person who felt they had not been involved in planning their care, and who was not sure whether or not they had been detained under the Mental Health Act. This person wanted to be able to spend more time talking to nurses. Another person told us that they wanted nurses to come to patients, rather than patients having to approach staff who might be too busy to talk.

Two people told us they had been involved in planning their care. One person said “I have been involved in planning my care while on this ward, for the first time since I got ill two years ago”. This person gave an example of how the core team had worked with them to plan a visit home, and to review how the visit had gone and plan the next visit. This person said they had signed their care plan.

We spoke to one person who was very positive about the care and support they had received. They were clear that they had been fully involved in care planning. They said that initially they had felt staff were not sorting out their problems quickly enough, but they now understood that at the time they were not ready for discharge. They were now very satisfied with the service they had received. This person was positive about staff and had no concerns about their care.

We spoke to four patients on the older people’s ward and none raised any concerns about their care. All of them felt that there were enough staff, that staff were helpful and friendly, and that they were being cared for appropriately. All said they felt safe. They told us that the meals were fine, and that drinks were available when they wanted them; staff tend to give drinks at regular intervals.

Other evidence

Our visit was a follow up to a review undertaken in March 2011 which found areas of non-compliance with this outcome relating to inconsistent quality and review of care planning.

We spoke to staff on the wards who told us that physical as well as mental healthcare needs are assessed on admission to the unit during a joint admission undertaken by a nurse and a doctor. Care plans are written to reflect the needs identified; the level of observation is decided based on risk assessments. Staff told us that there is a 72 hour care plan for the first three days, and a longer term care plan is written during this period. Care plans are then reviewed weekly with doctors, and the named nurse for a patient updates the care plan.

One member of nursing staff said that the nursing team are advocates for patient involvement in care planning, and that the multi-disciplinary team takes the lead in planning care. She told us that patients agree what they want to achieve on admission, and that this is reviewed with the doctor. People who are detained under the Mental Health Act have a weekly appointment for discussing their care with a doctor. The member of staff told us that patients who are not detained also regularly review their care with a doctor. However she said that they do not always have a weekly appointment for this, so may not always know when their care will be reviewed.

We spoke to a care assistant on one ward who said that she would discuss people’s physical care needs with them when they first met, and also read the care plans. She said that the ward manager ensures that there is always an appropriate balance of male and female staff to meet people’s personal care needs. She told us that patients were always involved in their daily care, and that she would always explain what she was planning to do and give the person a choice. They try to promote independence on the ward, but ultimately people can make a choice about what they want to do.

We asked staff on all three wards whether there were enough staff to provide the care people needed. Most staff said that there were enough staff, and one member of staff said that a period of low staffing due to maternity leave and staff sickness had now passed. We observed that there appeared to be enough staff to meet people’s needs.

One member of staff told us about a patient who had a serious physical illness which was deteriorating and will be terminal. When this person was admitted to the unit they were not able to make decisions about end of life care planning because of their mental illness. However having had treatment on the ward, they were now able to make these important decisions, and the multi-disciplinary team were working with the patient and specialists from other parts of the hospital and external agencies to review this person’s care and agree plans for the management of their physical and mental health needs in the future. This person had been involved in making decisions about their care; for example they had refused invasive interventions. We looked at this person’s notes and confirmed that this had been well-documented.

During our visit to the unit, we observed that people’s physical care needs appeared to be met. We saw that people on the older people’s ward looked clean and in appropriate clothing. We observed people being given afternoon drinks.

We saw that staff were talking in a quiet and friendly way to patients, and that staff were available to have one to one conversations with patients on the ward. On one ward people were gardening, and there was information on a wide range of ward-based therapy and activity groups on the wall of the ward. A member of staff told us that nursing staff now take responsibility for the timetable of the groups, and that nurses, occupational therapists, and external specialists run the groups. She felt that the groups work well. We spoke to