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Inspection report

Date of Inspection: 2 February 2012
Date of Publication: 29 February 2012
Inspection Report published 29 February 2012 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

We found that Mill View Hospital offered people safe, appropriate care which was tailored to their individual needs. Processes were in place to assess and manage individual risks.

However although we found the care records contained much information, it was not easy to locate relevant documents. The care plans did not always reflect the therapeutic care and nursing interventions undertaken. There was a risk that staff would not be able to provide appropriate care based on the information in the care plan.

We have minor concerns that the hospital may not be able to sustain compliance in this area and have set an improvement action upon the provider for these areas.

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 did not, on this occasion speak to people so cannot report what the people using the service said.

However the hospital forwarded the results of questionnaires completed by people who had recently used the service. The overall results were positive but noted that the hospital had received some negative feedback in relation to people not being included in decisions about their care and treatment, lack of involvement in the care planning process, the quality of food and the range of activities.

Other evidence

At our last visit to Mill View Hospital in August 2011 we found the service compliant with this outcome standard. However we had minor concerns that the delivery of care was not always safe, effective and flexible enough to meet individual needs. We also had concerns that people were receiving care and treatment in an environment which did not meet their specialist needs. This outcome standard was reviewed in order to assess how the service maintained safety for the vulnerable people using the service.

During this visit we spoke with the matron and ward managers responsible for the service. We spoke to clinicians and staff on the wards, attended a ward round and reviewed the documentation the hospital used. On the day of our visit Meridian Ward was closed for refurbishment and we did not visit Pavilion Ward as our previous concerns did not relate to this ward.

We were told that since our last visit a process for auditing people’s experience on the ward had started. This involved the manager and other people such as occupational therapists visiting each ward, talking to staff and patients and checking the general environment. Improvements following this programme of audits included the replacement of notice boards, updated menus and more art work throughout the building. The audit also focussed on how staff responded to people and visitors. The findings from these checks were fed back immediately to staff. The matron told us that staff were also undertaking customer care training.

Each ward also held weekly meetings where people could raise concerns and discuss their experiences on the ward. The issues were then fed back to staff at the weekly ward business meetings.

The matron told us that since the last inspection the hospital had reassessed the general environment for ligature points and was taking remedial action where possible. This included reviewing the documentation and ensuring all staff had received the appropriate training in suicide prevention.

We asked staff how they safely managed people who were assessed as a high risk. They explained the risk assessment process which included intermittent observations to keep people within eyesight or at arms length. They demonstrated how these observations were recorded. A charge nurse told us that the staff “manage a lot of risk on the ward” and that “they are good at it”. However we were told that they were aware that the “management of the risk may need to be recorded more” especially by care assistants.

Staff told us about the improvements to the environment and described the Applied Suicide Intervention Skills Training (ASIST) they had recently completed. We looked at the training matrix for the unit and saw that the majority of staff had received this training. The training was induction training related to suicide prevention and minimising potential risks.

During our visit we sat in on a ward round with the permission of individual people. We noted that this was a regular arrangement where each person could have a private meeting with the consultant psychiatrist, junior doctor and the charge nurse. The meeting was undertaken in an informal setting where people had the choice about where they wished the meeting to take place. We saw that future plans and discharge arrangements were discussed in an open manner that encouraged people to answer in their own time and to ask questions in a calm and unhurried atmosphere.

A record of the meeting was made and we were told that a copy was later given to the each person. We saw that records of the meetings included any issues of concern that were raised and discussed, the plan of care for psychological, physical and social care needs and any barriers to meeting those needs.

We looked particularly at the care and treatment of vulnerable people. We saw that one person was being monitored by “eye sight” observations for their own safety. This involved staff spending an hour at a time, observing the person