- Independent mental health service
Grove Park
All Inspections
During an assessment under our new approach
1 February 2023
During a routine inspection
Grove Park is a hospital that has two acute mental health wards for adults of working age and 2 nursing units for older adults with complex needs. We inspected both the hospital and nursing home parts of the service. This report details the findings from the hospital inspection and a separate report details the findings from the nursing home inspection.
This was the first time we rated this service. We rated it as requires improvement because:
- Staff had not carried out a full ligature risk assessment of the mental health unit. This meant that there were potential ligature risks which did not have clear mitigation in place and therefore posed a risk to patient safety.
- There were blanket restrictions in place on the wards. Patients were unable to make hot drinks or snacks without staff support.
- Staff were unaware of the provider’s physical health and wellbeing policy which led to inconsistencies in how often physical health monitoring was being carried out on each of the wards.
- The service had a 37% vacancy rate for nurses and a 45% vacancy rate for healthcare assistants. The service used bank and agency staff to fill any gaps.
- We found gaps in physical health monitoring charts which had not been picked up through the provider’s quality assurance processes.
- The provider did not ensure that their risk register was kept up to date.
- The service did not have an Occupational Therapist and we found instances where patient’s needs had not been assessed.
- Patients told us they had not been involved in their care planning.
- The area where emergency drugs and equipment were stored on Westborne ward was very cluttered and we were concerned this could cause a delay in staff accessing these items in an emergency.
- The provider did not have a clear process in place around the completion of Venous thromboembolism (VTE) assessments.
- Staff did not always ensure capacity assessments were carried out when patients had important decisions to make.
- Staff had not documented whether discussions around consent to informal admission had taken place with patients.
- The provider had improved their mandatory training compliance since their last inspection, however, compliance with some courses was still low.
However:
- The ward environments were pleasant and clean. The wards had enough nurses and doctors. They managed medicines safely and followed good practice with respect to safeguarding.
- Managers ensured that staff received supervision. The ward staff worked closely with those outside the ward who would have a role in providing aftercare.
- Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983.
- Staff treated patients with compassion and kindness and understood the individual needs of patients.
1 February 2023
During a routine inspection
Grove Park is a hospital that consists of two nursing units which provides nursing and personal care for up to 58 older people with complex needs, and an acute inpatient mental health service for adults of working age in two wards (nine beds on each). At this inspection, we only inspected the nursing units and there were 43 people living there.
People’s experience of using this service and what we found
The required improvements had been made since the last inspection in respect to the recording of food and fluids, relevant training for staff and having robust systems in place to monitor and improve the quality of the service.
The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and the provider learned from any mistakes. Our own observations and the feedback we received supported this. Staff had received appropriate training and people received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.
People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were enough staff to care for them. Our own observations supported this, and we saw friendly relationships had developed between people and staff.
People received medicines safely. The service was clean, hygienic and a pleasant environment to spend time in. People’s care plans were up to date and accurately reflected their needs. People were able to receive visits from their relatives and there was a programme of activities to support their well-being.
Staff worked collaboratively with outside agencies such as the local authority and healthcare professionals. People were protected from harm and abuse, as staff knew how to safeguard people and what procedures they should follow. Complaints were responded to appropriately and people’s wishes at the end of their life were respected. People were able to express their views and had their dignity, independence and privacy promoted.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service had Insufficient evidence to rate (published 23 September 2022) and there were breaches of regulation. We did not rate this service at that inspection because we did not look at the key questions in full. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from insufficient evidence to rate to good based on the findings of this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
10 August 2022
During an inspection looking at part of the service
Grove Park is a hospital that consists of one nursing unit which provides nursing and personal care for up to 31 older people with complex needs, and an acute inpatient mental health service for adults of working age in two wards (nine beds on each). At this inspection, we only inspected the nursing unit and there were 24 people living there.
People's experience of using this service and what we found
People’s hydration intake was not being effectively monitored to reduce the risk of dehydration. Incidents were not recorded fully and did not show actions taken to minimise the risk of further incidents. They were also not monitored to identify trends. People had individual risk assessments in place to help manage and minimise risks. There were high levels of agency staff which meant there was a risk of staff not knowing people’s needs and risks well.
Staff had not all completed the provider’s mandatory training. This meant that staff did not always have the required skills to carry out their roles effectively and safely. Staff had not been receiving supervision or regular team meetings to adequately support them. People’s eating preferences and needs were being catered for. Staff told us that this had recently improved and prior to this people who required a special diet was not consistently receiving what they needed. People’s physical healthcare was assessed and supported, and people had access to GP’s and other healthcare professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However; the provider did not consistently record that consent was sought by the person, a next of kin or Power of Attorney.
Quality assurance systems were not robust which meant areas of improvement were not identified or acted upon. There was not adequate management oversight of the service. There were not effective or detailed policies and procedures in place for staff to follow. Managers did not ensure that staff were adequately trained or supported.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We received concerns in relation to the safe care of people on the unit. As a result, we undertook a focused inspection to review part of the key questions of safe, effective and well-led only.
Grove Park was registered with the CQC in February 2022. We inspected the mental health wards in June 2022, but this was the first time we inspected the nursing unit. We did not rate this service at this inspection because we did not look at the key questions in full.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment of people, staff training and support and the management processes of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
29 June 2022
During an inspection looking at part of the service
Grove Park is a hospital that provides acute inpatients mental health services for adults of working age in two wards (nine beds on each) and one nursing unit which provides care for 31 older people with complex needs.
We inspected the acute inpatient mental health wards at Grove Park on 29 June 2022. This was an unannounced, focused inspection following information of concern we received about the safe running of the service. These concerns were about poor staffing levels and staff competence, the management of patient’s risk and the way physical health monitoring of patients was being carried out The service had suspended admissions following concerns raised by the local NHS trust commissioning the acute inpatient mental health beds and therefore there were only four patients on the wards at the time of the inspection.
As this was a focussed inspection, we did not inspect any of the key questions in full so did not award ratings.
- The service did not consistently provide safe care. The service had in the week prior to inspection, following concerns being raised by a number of sources, reviewed all risk assessments for the current patients. These had improved but prior to this, risks were not being managed effectively.
- At the time of the inspection there were no emergency medicines on the wards. Managers told us that these had been ordered but we found that no one had followed up on these and they had not been received. This meant that the service would not be able to respond appropriately in the event of an emergency placing patients at significant risk. We raised our concerns with the service; managers confirmed that emergency medicines had been received 15 days after the inspection.
- There were not enough staff trained in immediate life support (ILS) to respond in a timely manner to emergency medical situations. This training had been booked but staff had not yet completed it. This meant there were not always staff on site with ILS training to respond to medical emergencies or who could administer the emergency medicines. Staff had not all received mandatory training to ensure they were competent and confident to carry out their roles and keep patients and staff safely.
- Staff did not develop detailed care plans in a timely manner for patients on admission. Managers did not ensure that staff received training, supervision and appraisal in line with their policy and best practice. Patients did not receive all physical health assessments in line with best practice on admission.
- Staff did not carry out venous thromboembolism (VTE) assessment in line with National Institute for Health and Care Excellence (NICE) guidelines.
- The service was not well led. The provider did not have a robust governance system to assess, monitor and make improvements to the service. Leaders did not have clear oversight of the safety and quality of the services.
However:
- Prescribed medicines for the four current patients were managed safely.