Castle Lodge Independent Hospital

We rated Castle Lodge Independent Hospital as requires improvement because:

• The minimal levels of qualified nurses on shift were low for the mix of patient needs; the delayed recruitment of a clinical lead that had been of ongoing concern for over six months contributed to this.
• A lack of onsite cover from the responsible clinician, made it particularly difficult when a patient in the hospital needed detention.
• The range of mental health professions in the multidisciplinary team was too narrow to meet the psychological needs of patients in the hospital.
• The complex systems in place within medicine folders, involved a great deal of paperwork for each patient, increasing the risk of a medicines error.
• Care planning documents were not easy for staff to navigate, creating the possibility that important detail and patient choices could be missed.
• There was no clear model of care, care pathway and limited evidence-based practice.
• Patients were not always supported to maintain independent living skills.
• Key decisions about care made at ward rounds did not routinely involve patients, their relatives or an independent advocate.
• There was no clear criteria for admission to or discharge from this service.
• The hospital described an inappropriate discharge pathway: moving patients from detention under the Mental Health Act 1983 onto Deprivation of Liberty Safeguard under the Mental Capacity Act 2005, this highlighted a lack of understanding of the legislation.
• Capacity to consent and best interest decisions were not comprehensively completed or documented; the narrative as to how the assessment had been conducted was not evident from the documentation.
• Advanced decisions in place did not follow a transparent process, nor was recording completed with the detail required.
• Staff did not understand their individual responsibility in relation to the Mental Capacity Act 2005 to be able to apply this in practice.
• Barchester policies had not been updated or re-written to ensure compliance with the Mental Health Act Code of Practice.
• The hospital did not analyse reported risks to patients and staff effectively. There were no structures to ensure staff and managers learned lessons from incidents or complaints.
• Training record systems offered a lack of clarity for training figures; only 45% of staff had completed infection control training in the past year and no staff members were in date with equality and diversity training.

However,

• Staff knew patients well and responded to their needs, engaging with patients in a genuine, caring and respectful manner.

• Patients and carers became involved in the initial comprehensive admission assessment, which included physical health checks and care planning.
• Individual patient risk assessments including falls, linked to individual care planning for each patient.
• Patients received one to one time with staff, talking or engaging in activities.
• Staff understood their responsibilities to safeguard the patients in their care.
• The head chef worked closely with staff to meet specific dietary needs and patients had facilities to drinks and snacks 24 hours a day.
• Patients and relatives could become involved in community meetings about the service.
• The staff team on night duty spoke positively about their work and the support they received from each other.
• Detention paperwork was correctly completed, up to date and stored appropriately.
• Staff records included documented evidence that all staff had received an annual appraisal and regular managerial supervision.