Pathfinder Ashness House

Updated 6 April 2023

We undertook this unannounced, comprehensive inspection of Pathfinder Ashness House to follow up on changes made as a result from our focused inspection in September 2022 and to rate the service for the first time.

At our inspection in September 2022, we found instances of unreported physical restraint, incidents of restraint that were not clearly recorded and staff administering rapid tranquilisation and not carrying out the required post administration physical health monitoring. We served a section 29 Warning notice which required the provider to make improvements by November 2022.

Pathfinder Ashness House is in Harrow, North West London. The service is provided by Pathfinder Group Healthcare Limited and registered to provide the following regulated activities:

• Assessment of medical treatment for persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder or injury.
• Diagnostic and screening procedures.

The service provides long stay/rehabilitation services to male adults of working age with complex mental health issues. The service has 26 beds. Seven of the 26 beds are high dependency, supporting people that need extra support. In addition, the service has two flats for patients getting ready for discharge. On the days of our inspection, there were 10 patients receiving care at the hospital – with 3 of these patients admitted to the high dependency unit.

Nine patients were detained under the Mental Health Act (1983).

The service registered with the CQC in March 2022. We have not previously rated this service.

At the time of the inspection, there was a registered manager in place.

What people who use the service say

We spoke with 5 patients on the ward. Patients said staff treated them well and behaved kindly towards them. Patients said staff were willing to listen and that they felt respected. Another patient had requested a battery-operated lawn mower and staff facilitated this to support with gardening.

Whilst patients reported that they knew about their care plans, three patients reported that they had not been given a copy.

Three patients did not know what their discharge plan was.

Two patients said staff discussed quitting smoking with them. One patient said they were not supported with their physical health needs.

Updated 6 April 2023

We carried out an unannounced, comprehensive inspection of Pathfinder Ashness House. We have rated the service for the first time. After a focused inspection in September 2022 identified serious concerns, we went back to check the provider had made improvements.

The hospital had made progress in addressing the concerns identified at the last inspection. This included clearly documenting when staff restrained patients. Staff ensured they clearly documented patients’ physical health observations after they administered rapid tranquilisation. Staff adequately monitored the administration of rapid tranquilisation through robust audits.

At this inspection we rated safe, caring, responsive and well-led as good and effective as requires improvement.

We rated this location as good because:

• The service had addressed the concerns raised at the last inspection in September 2022. The service had made improvements to how they managed and safely restrained patients. Staff had made improvements to how they carried out observations and engagement with patients. Staff had improved how they documented patients’ physical health observations after they administered rapid tranquilisation.
• The service had enough nursing and medical staff, who knew the patients and received essential training to keep people safe from avoidable harm. Although the unit had a high number of vacancies, the service had enough staff on each shift to support patients safely. The service provided staff with emergency scenario training to help staff prepare for a medical emergency.
• Staff managed medicines safely and regularly reviewed the effects of medications on each patient’s mental and physical health.
• The ward environment was safe and clean. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients undergoing rehabilitation. The service had a full-time responsible clinician. Managers ensured that staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who had a role in providing aftercare.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Staff felt respected, supported and valued. They said the provider gave them opportunities for development and career progression. They could raise any concerns without fear.

However:

• Staff did not always discharge their roles and responsibilities under the Mental Health Act 1983 in a timely way. Patients detained under the Mental Health Act did not always have their rights explained to them in a way they could understand. An audit of the Mental Health Act patient files did not effectively monitor how the Mental Health Act was implemented at the hospital.
• Staff had not displayed written information to inform patients of what items were prohibited. Not all staff knew about what restrictive practices there were on the ward.
• Staff used some generic statements in patients care and treatment records. Patient goals were not always specific, measureable and achievable.
• Staff did not always help patients to live healthier lives. The hospital site was not smoke-free as patients could still smoke in the garden area. This was not in line with best practice.

Updated 6 April 2023