The Care Quality Commission
  • Mental Health
  • Independent mental health service

Bromley Road Hospital

Overall: Good read more about inspection ratings

84-86 Bromley Road / 82 Canadian Avenue, London, SE6 2UR (020) 8695 6051

Provided and run by:
Elysium Healthcare Limited

All Inspections

29 & 30 November 2024

During a routine inspection

Our rating of this service stayed the same. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean and staff managed environmental risks well. The wards had enough nurses. The service had successfully over-recruited to its nurse vacancies. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They 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. This included psychology and occupational therapy support aimed at developing patients daily living skills. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • 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 and 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 and the Mental Capacity Act 2005.
  • 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.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for anything other than a clinical reason.
  • The service worked to a recognised model of mental health rehabilitation. It was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Although the service was working to embed a more robust approach to out of hours medical cover, there was a present risk that the substantive consultant psychiatrist might be difficult to get hold of whilst they were off work.
  • Staff had been recording routine physical health checks on two separate records, and there were delays to some patients’ annual physical health checks (required because they were prescribed high-dose antipsychotic medicines). These issues had not been identified by the provider’s internal governance systems.
  • The service did not currently have a registered nurse lead for physical health. Although a nursing assistant did hold this role, staff needed to be supported appropriately to manage and monitor patients’ physical healthcare needs, which, we noted, were significant.

7, 8 & 9 November

During a routine inspection

We rated Bromley Road Hospital as good because:

  • The service had addressed the concerns raised following the last inspection in May 2017. For example, staff treated patients with dignity and respect. Staff no longer imposed inappropriate blanket restrictions on patients. The service provided adequate medical cover for patient care. The service had made improvements to ensure managers used effective systems to monitor the performance of the service.

  • Staff developed personalised, recovery-oriented care plans and supported patients to give their views and develop recovery goals. Staff completed positive behaviour support plans. These plans contained strategies that focused on patients’ challenging behaviour. Staff 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 best practice guidance.

  • The ward teams included, or had access to, the full range of specialists required to support patients with their rehabilitation. This included an occupational therapist, social inclusion worker and a clinical psychologist.

  • Staff supported patients to live healthier lives. Staff assessed patients’ physical health needs on admission. Patients took part in the service’s programme to encourage patients to think about their physical health and take part in various exercises.
  • Staff effectively planned for patients’ discharge and worked well with other agencies to do so. Staff created projected discharge dates on admission for each patient as a goal to work towards.
  • Staff treated patients with kindness, dignity and respect. Patients said that they felt staff were kind, friendly and always supported them with their care and treatment. We observed positive interactions between patients and staff. The service held an annual talent contest for patients. Patients really enjoyed taking part and rehearsals were well attended.

  • The service provided safe care. Staff completed risk management plans with input from patients and the multidisciplinary team. Staff minimised the use of restrictive practices, managed medicines safely and carried out regular physical health checks such as, blood tests and monitoring patients’ vital signs.

  • The service was working towards a model of mental health rehabilitation. The provider had introduced a new rehabilitation model of care to be implemented at the service in January 2019. Improved governance processes ensured that ward procedures ran smoothly. Managers had accessible systems that provided oversight of the quality, safety and performance of the service.

However:

  • Staff did not always actively promote the needs of all patients, including those with a protected characteristic. The service could do more to encourage an open and inclusive environment to support patients’ sexual, cultural and spiritual preferences.
  • Although patients in the service were low risk in respect of self-harm and suicide; staff assessments of ligature risks in the service did not record all control measures for staff to reduce the risks to patients.
  • Some parts of the building were run down and required some maintenance and refurbishment. The service had a schedule of works planned to improve the decoration and maintenance of the building.

  • Although staff received regular supervision in the service; staff supervision records were brief and lacked detail. Records did not demonstrate that these sessions were effective in ensuring the learning and development of staff and delivery of high quality care.

30 and 31 May 2017

During a routine inspection

We rated this service as requires improvement because:

  • The service did not have adequate medical cover to meet the needs of the patients. Regular reviews of patients care and treatment where not always taking place due to the lack of medical cover at the service.
  • Staff did not always treat patients with dignity and respect. Patients we spoke with said that staff were not always caring towards them and some were rude towards them. We observed poor interactions between staff and patients.
  • The service had some inappropriate restrictive practices in place. Staff conducted random weekly room searches on both units to support patients to maintain their bedroom environments. This was restrictive and not based on individual patient need.
  • Whilst care and treatment records were holistic and personalised, these were not always updated when patients were reviewed by the consultant psychiatrist or met with their named nurse for one to one’s.
  • Effective systems to monitor, assess and improve the service were not always in place.
  • Systems used to monitor compliance with some mandatory training were not effective and data relating to compliance rates for information governance and infection control training was not reliable.
  • The manager had raised issues with staff about poor time management and poor team working in recent team meetings, but not about staff professional conduct towards patients
  • The emergency resuscitation bag was missing some essential equipment, for example, suction tubing, which was a vital item to have in an emergency.

However,

  • Following our last inspection of the service, in February 2016, we told the provider they must make improvements to ensure staff complete mandatory training, they submit all notifications to the CQC and that medicines management was safe. At this inspection, we found that the management team had effectively implemented changes.
  • Staff assessed any risks to patients in detail, regularly reviewed and amended plans to manage the identified risks. Staff observed patients within the service as convex mirrors had been installed to mitigate blind spots. The service had a complete and up to date ligature risk assessment, to reduce the risk of ligatures being used.
  • All staff had received training in safeguarding adults and children from abuse. Staff had received immediate life support training from the resuscitation council. Staff received an annual appraisal of their work performance and received regular managerial supervision.
  • Staff undertook a comprehensive assessment of patients prior to admission. Patients had physical examinations and mental health assessments. The service specialised in taking patients with physical as well as mental health needs. Nursing staff were registered mental health nurses who had experience working in general and mental health services.
  • Patients knew how to make a complaint about the service. Staff carried out investigations when patients complained. The service conducted a patient satisfaction survey in 2017. 

16-17 & 26 February 2016

During a routine inspection

We rated Bromley Road Hospital as requires improvement because:

  • There were low completion rates of mandatory training. Many staff had not completed essential safeguarding, managing violence and aggression and breakaway training and the provider had difficulty in providing clear data regarding the completion of mandatory training amongst the staff group.
  • There were low rates of supervision amongst the nursing team, which meant that staff did not have regular monthly support in line with the provider’s supervision policy.
  • Patients were prescribed high dose anti-psychotics, which heightened the risk of cardiac problems. However, the records of the numbers of staff who had been trained to use the defibrillator prior to February 2016 were not available.
  • The provider’s management of medicines was not robust. They had not actioned all aspects of the pharmacy audit. Staff had stored and disposed of medicines incorrectly. There were out of date vacutainers being used to collect blood samples.
  • The provider had not responded in a timely manner to the issues regarding the lack of hot water at the hospital.
  • The provider had not notified the Care Quality Commission of all the events that they should have. The provider had not notified the CQC of the unauthorised absence of a person detained under the Mental Health Act 1983.
  • The provider failed to notify the CQC of two incidents that had been reported to or investigated by the police

However:

  • All areas of the hospital were clean. There was ongoing refurbishment work to improve the condition of the hospital.
  • Patients were involved in the development and review of their care plans.
  • The provider undertook an annual patient survey and used the responses from patients to improve the service.
  • There was a mix of recovery-orientated and leisure activities every day. Activities took place both at the hospital and in the community.
  • The service valued the diversity of patients by supporting patients with their religious and spiritual needs and celebrating events like Black History Month and World Mental Health Day. 

9 October 2013

During a routine inspection

People using the service told us the staff supported them and were helping them to manage their own health and finances. They felt their mental and physical health needs were being well looked after. People told us they enjoyed the social aspect of the service and being able to speak with other people in a similar situation to them.

Care and treatment was planned and delivered in line with their individual care plan. We saw that care plans addressed people's physical and mental health needs, and identified social or financial support needs. An assessment of risks had been completed and management plans were in place to minimise those identified risks.

People were safeguarded against the risk of abuse. Staff were aware of potential signs of abuse and demonstrated knowledge in appropriate reporting procedures. There were processes in place to ensure people were protected from financial abuse.

There were enough qualified, skilled and experienced staff at the service. There was a multi-disciplinary team in place to support people using the service. We saw evidence that shifts were staffed appropriately and additional staff were available to support people using the community and those that had higher support needs.

Staff were supported to attend training courses and develop their skills and knowledge. A process of regular supervision and annual appraisal was in place to support staff and identify areas for development.

People using the service had an opportunity to comment on the service they received through community meetings and 'service user representatives'. There were processes in place to manage and respond to complaints and incidents.

At our previous inspection we found that improvements were required regarding people's care records. At this inspection we found that improvements had been made. The care records contained information on people's risks and the care and support they required.

27 February 2013

During a routine inspection

During this inspection we spoke with six patients and seven members of staff, looked at three full sets of patient notes and some further patient and staff records.

Patients we spoke with said they were involved in decisions about their care and understood why they had been admitted to the hospital. No-one we spoke with raised any concerns about staff or the hospital with us. Patients were able to choose what activities they took part in and told us they valued the activities. There was a choice of suitable and nutritious food and drink, and patients were encouraged to eat healthily.

At a previous inspection on 29 February 2012 we had moderate concerns about how the provider was managing medicines, but at this inspection we saw the provider had appropriate arrangements in place to manage medicines.

However, there was a risk that patients might receive unsafe or inappropriate care and treatment which met their needs and protected their rights, because so many care records were incomplete or out-of-date and because nursing one-to-one sessions were so irregular.

24 October 2011

During an inspection looking at part of the service

This was a follow up inspection to check on improvements required by our previous inspection in October 2011.

At this follow-up inspection in February 2012 most patients we spoke to understood how they were being involved in their care and how and when their discharge might take place.

Everyone knew who their named nurse was, but some felt that they had no say in who their nurse was and one felt their named nurse was unsuitable for his needs.

Doctors had discussed peoples' medicines with them, and they had given people both verbal and written information on any possible side effects of their medicines.

Most patients felt safe and secure in the hospital, or had spoken to staff and had strategies in place to minimise any potential or perceived risks.

People told us about issues, such as that the washing machine being out of order for several days, problems with a faulty shower, and that food was not appetising or sufficient for their needs. They said they had raised these issues with staff but that they were not aware of what was being done to address the problems.

People also said that staff used 'jargon', which they said was a barrier to their participation, and some said they would like more opportunities to take part in physical activities.

24 October 2011

During a routine inspection

Patient satisfaction with staff was generally high. Most people felt able to plan their own activities, days, budgets and shopping needs without any help, although some would have liked more support to access further education or return to work opportunities, and many were critical of the standard and variety of the food and other culturally appropriate provision at the hospital.

Some patients we met said they felt tired or exhausted. A third of patients said they did not know what illness they were being treated for, but most felt they knew how to prevent themselves from becoming unwell again. The majority knew what medications were prescribed for them and what they were for; a third stated they were having side effects from medication and approximately half of these felt they had not been given help to minimise the medication side effects.

People said they had not been given copies of their own care plans and they told us they did not feel involved in their care planning, although one person we spoke to felt they had participated in writing their care plan.

People did not fully understand the role of an advocate, only 28% had used the advocacy service, and some patient information was out of date. Detained patients were not clear about what was required for them to be discharged from the hospital back into the community, or of their rights under the Mental Health Act, and some were not being given copies of their leave forms.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.