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Inspection report

Date of Inspection: 26 March 2013
Date of Publication: 15 June 2013
Inspection Report published 15 June 2013 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

We looked at the personal care or treatment records of people who use the service, carried out a visit on 26 March 2013, observed how people were being cared for and talked with staff. We reviewed information we asked the provider to send to us.

Our judgement

People experienced care, treatment and support that met their needs and protected their rights.

Reasons for our judgement

At our last inspection of Millview Hospital ion the 2 February 2012 we found the service compliant with this outcome standard. However we had minor concerns that it was not easy to locate relevant information in the care records. 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 limited information in the care plan. We also had concerns that people received 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 inspection we spoke with the hospital manager, ward managers, staff and clinicians responsible for the service. We spoke to clinicians and staff on the wards and reviewed the documentation the hospital used. We looked at the care and treatment for patients who were particularly vulnerable and at risk from environmental hazards.

We found that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. The hospital had continued with the initiatives started following the last inspection. This included assessing the general environment for hazards on a regular basis, regularly reviewing the documentation and ensuring all staff had received the appropriate training in suicide prevention. We looked at staff training records and saw that staff across the hospital had undertaken training in Applied Suicide Intervention Skills Training (ASIST). We were told there were gaps in staff training in relation to fire safety and ligature and risk assessment training but that the ward managers monitored this. This meant that the Trust ensured staff were prepared to manage the risks associated people with acute mental health problems.

We looked at a sample of care records for people who were particularly vulnerable on each of the wards we visited. We were able to locate the information we needed quickly. Each of the care records we looked at contained a detailed initial assessment, risk assessments, a daily record of care given, clinical interventions and a care plan. There was evidence of good nursing risk evaluation and written evidence that demonstrated prompt nursing referral and assessment by medical staff when risks increased. However the provider may wish to note that the care plan documentation contained gaps between entries. This meant that there was a risk that records could easily be falsified or entries made some time after the event which is not best practice in record keeping.

We were told that all care plans were audited monthly to ensure that the care records reflected the risk assessments in place. We were told that the hospital undertook a random audit of care plans which fed into the Trust wide records audits. The records audits also looked at ensuring that patients were involved in their care planning. The records we looked at demonstrated that, where possible, patients had been involved in planning and agreeing with their plan of treatment and support. This meant that people’s care and support was planned in line with their need and preferences.