Background to this inspection
Updated
30 August 2016
Bigfoot Independent Hospital provided care and treatment for up to 28 male patients with a primary diagnosis of learning disability or autism.
The provider was registered to carry out the following regulated activities:
- Diagnostic and screening procedures
- Assessment or medical treatment for persons detained under the Mental Health Act 1983
- Treatment of disease, disorder or injury
There were five wards at the hospital; on the ground floor there was Da-Vinci ward which had six beds and Dali ward which had six beds. On the first floor there was Picasso ward which had six beds and Monet ward which had six beds. On the second floor was Matisse ward, which had four beds.
At the time of inspection, there were 16 patients at the hospital.
The previous registered manager and general manager had left shortly after the inspection in March 2016 and a new hospital manager and general manager had been in post for three months and two months respectively at the time of the current inspection.
The hospital has been registered with CQC since 4 January 2011. There have been seven inspections carried out at this service. The most recent inspection was conducted on 21-23 March 2016 and the hospital was rated as inadequate with breaches to seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Warning notices were served for breaches of four regulations and we issued requirement notices for breaches of a further three regulations were made subject to requirement notices. The service was also placed into special measures. Three of the warning notices had compliance dates of June 2016 and these are the three we followed up. They were for breaches of:
- Regulation 10 Dignity and respect
- Regulation 12 Safe care and treatment
- Regulation 18 Staffing
Updated
30 August 2016
The CQC 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, and there remains a rating of inadequate overall or for any key question, we will take action in line with our enforcement procedures. At this point, we would begin the process of preventing the provider from operating the service. This will lead to cancelling the providers' registration at this service, or 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.
We rated Bigfoot Independent Hospital as inadequate because:
- There was poor governance in relation to the oversight of issues arising at the hospital and communication between the hospital management and the operational and board level.
- There was poor oversight and awareness of the Mental Health Act 1983 and the Deprivation of Liberty safeguards.
- The hospital was not managing medicines safely. We found several examples of dangerous medicines management including intramuscular medication given without a valid prescription, the wrong doses of medication given, patients being treated with high dose antipsychotic medication without additional monitoring, out of date medication and dressings and unsafe storage in the form of malfunctioning medicines fridges.
- We were concerned about staffing levels across the service, particularly within one ward with complex patients who required high levels of support. Staffing levels of qualified nursing staff were not safe. Qualified nurses on duty covered more than one ward, particularly during night shifts but also during the day.
- Staff did not receive the training required for their role. We found that staff had received basic one day training in learning disability, with no training in autism, communication needs and assessment, epilepsy or person centred planning.
- There was a lack of rehabilitative focus, with little evidence of discharge planning, little structured rehabilitative activity or assessment, poor access to psychological input and very little evidence of outcomes planning, monitoring or progress for patients. There were no links into community rehabilitative or structured resources or support to access these.
We raised our concerns about the quality of care being provided at the time of the inspection.
The provider took immediate steps to address shortfalls which included:
- extra senior management support
- an increase in staff,
- commissioned an independent review of all detention papers,
- an investigation into the detention errors and addressing the issue of informing patients and relatives
- changing provision of pharmacy support.
We also shared our concerns with the commissioners of the service. We have taken enforcement action and we will be working with the provider to ensure that improvements are made.