Ellern Mede Derby

Updated 15 January 2024

The hospital opened in July 2022 and had its first comprehensive inspection as part of our ongoing monitoring and inspection of registered services in February 2023, where the service was rated as good overall. This inspection was a focussed, unannounced inspection of the service following information of concern around patient safety.

Ellern Mede Derby is a hospital run by Oak Tree Forest Limited. The service provides inpatient services for children and young people with eating disorders aged 8 to 25 years. The hospital is for children and young people of all genders. The hospital offers 17 inpatient beds across two units; Derwent ward and Trent ward. Derwent ward is on the first floor for young people aged 8 to 18 years. Trent ward is on the ground floor is currently closed as part of the services gradual opening and is planned to be for 18 to 25 year olds. At the time of inspection, there were 6 young people aged between 11 and 17 years admitted to Derwent ward. The hospital has an onsite school to provide children and young people with an education during their admission.

The hospital did not have a manager registered with the CQC in post at the time of the inspection but was being supported by the provider’s clinical operations director and special projects director, with the newly appointed manager due to start in January 2024.

The hospital is registered by the CQC to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.

• Diagnostic and screening procedures

• Treatment of disease, disorder, or injury.

The main service provided by this hospital is specialist eating disorder service for children and adolescent mental health services.

At this inspection we did not inspect all areas of the key questions because this was focussed on specific areas of concern. We inspected against the key questions of safe, effective, responsive and well led. We re-rated the service as requires improvement.

What people who use the service say

There were 6 young people using the service when we inspected. We spoke to 2 young people using the service and 6 family members and carers.

Both young people knew what items were restricted on the ward area and why and been involved in their individual risk assessments for this. Both young people felt there were not enough activities at the weekends. They felt some staff treated them well but other did not and they had raised complaints, but they had not been responded to. They knew how to access an advocate as they visited the ward every week.

We spoke to 6 family members. Five felt the permanent staff were good and caring. Three family members felt training for agency staff was an area of improvement the service needed to address.

Four felt they were kept informed and were actively involved in care and treatment, but 2 family members did not feel listened to or involved in their child’s care and treatment.

All family members were aware of restraints, but one was concerned about the restraint due to their child telling them they were hurt, and one felt their child was unfairly restrained when they were nasogastric tube fed.

Two family members felt the family visit room and facilities could be improved, particularly for those that are visiting from a long distance.

Updated 15 January 2024

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

• The service had a clear and detailed treatment model in place but staff did not complete appropriate, regular physical health checks and document detailed treatment plans in line clinical guidance and the service model.
• The service had high healthcare assistant vacancy rates and a reliance on temporary agency staff.
• Staff did not complete post incident checks, including neurological observations of young people and body maps when young people had sustained injuries.
• The service did not always complete patient searches and log these in line with the service policy after a young person had taken leave, increasing the risk of items being secreted onto the ward area.
• Care planning documentation did not always give a detailed rationale around the treatment plan prescribed for young people, particularly around physical health needs and mental state for young people who were at a healthy weight for their height.
• Young people did not have adequate storage for their belongings and staff did not manage items of potential risk safely, increasing the risk of young people’s belongings being lost or a potential safety incident occurring.
• Governance processes did not always ensure that ward procedures ran smoothly. The processes in place did not always identify gaps in post incident checks, gaps in young people’s physical health checks and gaps in young people’s care planning.

However:

• The ward environments were safe and clean. The wards had enough nurses and doctors to keep people safe.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
• The service delivered tailored training specific to the service.
• Staff felt listened to and able to influence service delivery. Staff spoke positively about the service and were proud of their work and enjoyed their role.
• The service provided psychological therapies in line with national guidance.

Updated 15 January 2024

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

• The service had a clear and detailed treatment model in place but staff did not complete appropriate, regular physical health checks and document detailed treatment plans in line clinical guidance and the service model.
• The service had high healthcare assistant vacancy rates and a reliance on temporary agency staff.
• Staff did not complete post incident checks, including neurological observations of young people and body maps when young people had sustained injuries.
• The service did not always complete patient searches and log these in line with the service policy after a young person had taken leave, increasing the risk of items being secreted onto the ward area.
• Care planning documentation did not always give a detailed rationale around the treatment plan prescribed for young people, particularly around physical health needs and mental state for young people who were at a healthy weight for their height.
• Young people did not have adequate storage for their belongings and staff did not manage items of potential risk safely, increasing the risk of young people’s belongings being lost or a potential safety incident occurring.
• Governance processes did not always ensure that ward procedures ran smoothly. The processes in place did not always identify gaps in post incident checks, gaps in young people’s physical health checks and gaps in young people’s care planning.

However:

• The ward environments were safe and clean. The wards had enough nurses and doctors to keep people safe.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
• The service delivered tailored training specific to the service.
• Staff felt listened to and able to influence service delivery. Staff spoke positively about the service and were proud of their work and enjoyed their role.
• The service provided psychological therapies in line with national guidance.