Elm Park

Updated 23 December 2022

Elm Park is a specialist neuro-rehabilitation service treating people with complex neurological needs following a traumatic or acquired brain injury. Elm Park provides individual treatment programmes for men with complex behaviour issues, and those with a forensic history including patients detained under the Mental Health Act or informal patients. Elm Park has 17 beds and had nine patients at the time of our inspection. Elm Park is part of Priory Healthcare.

Elm Park provides the following regulated activities:

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

We previously inspected Elm Park on 26 June 2018. The service was rated good overall, being rated good for the effective, caring, responsive and well led domains. The service was rated requires improvement for safe. We identified a breach of the following regulation:

• Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

The provider had not ensured that management had identified and mitigated all ligature anchor points in the ligature risk assessment.

The provider had not ensured improvements were made to the physical environment and repairs were made in a timely manner.

We asked the provider to consider how staff could have clear lines of sight throughout the ward and to ensure that all areas of the hospital were kept to an appropriate standard.

What people who use the service say

We spoke with six patients and four carers.

The patients’ comments about the service were generally positive. Patients said that staff were approachable and quick to address issues when raised. One patient said there were no negatives with staff, the food or activities at the service, but would like access to reading books or the library. Another patient said the two drivers at the hospital were both on leave which meant there were no drivers to take them out. The same patient said there were no call bells in the bathroom and there were times when he needed help in the bathroom and had to shout for help, but no one came.

We spoke with four carers of patient’s using the service. One carer told us that members of staff were always available to talk to them, and that they believed patients’ felt safe and happy in the hospital. Another carer told us they were happy with the care and treatment received. During a home visit, two members of staff who accompanied the patient, were supportive. Carers felt they were able to speak to nurses whenever they needed to and were kept informed of any incidents relating to their relatives. However, one carer told us they were dissatisfied with the care of their relative as whenever they visited the hospital, they found their family member either with stained clothes or wearing someone else’s clothes despite having bought new clothes for them.

Updated 23 December 2022

Elm Park is a specialist neuro-rehabilitation service treating people with complex neurological needs following a traumatic or acquired brain injury. Elm Park provides individual treatment programmes for men with complex behaviour issues, and those with a forensic history including patients detained under the Mental Health Act or informal patients.

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

• The provider had not ensured that there had been sufficient numbers of suitably qualified, competent, skilled and experienced persons to meet the requirement of staffing. In 11% of shifts ward staffing numbers during the weekdays were below the required staffing levels of registered nurses. In 41% of shifts at the weekend there had been only one registered nurse on duty. In addition, 43% of early shifts did not have the required number of healthcare assistants on duty. There was one late shift in early May 2022 where the registered nurse arrived late, and the service was left without a registered nurse for a short period. We were concerned about the oversight at the service and the impact on patients. The service had a high staff turnover.
• Managers had not ensured that staff had been trained in stoma care, when they had a patient with stoma bag.
• The provider had not ensured that staff were in receipt of clinical supervision and appraisal. The figures for supervision between January and August 2022 were 47% for registered staff and 30% for unregistered staff. This included nursing, psychology and speech and language therapy staff.
• The patient call bell lead was not long enough to reach the bathrooms for patients with disability. A patient had to shout for help, and no one answered and had to help himself in the bathroom. This was not recorded as an incident. A patient with wheelchair was room bound for 2 days because the chair lift and main lift was broken.
• Due to current staffing levels, there had been no one to one individualised rehabilitation therapies for over six months. The treatment model of the hospital (as outlined in their mission statement) stated that therapies would be delivered on an individual basis. There were two occasions in the six-month period reviewed, when there was no registered nurse on duty. There was no incident reported in relation to these two occasions.
• The provider had not ensured that systems were in place to ensure that the cleaning of tumble drier lint, had been undertaken daily and had not ensured that all daily food safety checks and records had been completed.
• The medication key after a shift had been handed over to a non-clinical staff because there was no qualified nurse on the shift at the time of handover.
• There were gaps in the observation records of five patient records reviewed who were on different levels of observation.
• Managers had not ensured that patient emergency evacuation plans were in place for a patient who was unable to leave their room due to the ward lift being broken. Therefore, there were no plans in place to identify how staff should respond in the event of a fire.
• Managers had not ensured that systems and processes were in place to obtain feedback from staff, for the purposes of continuous evaluation and ongoing service improvements. Managers had not ensured that regular staff team meetings had taken place.
• Staff had not notified a patient of one incident involving a medication error in line with the duty of candour.

However:

• The clinic room was clean, organised and well equipped.
• The ‘as required’ (pro re nata; PRN) medication had been reviewed regularly with good prescribing practice.
• The occupational therapist assistant group activity was well attended by patients, and a manual register and daily orientation sheet were kept by the occupational therapist assistant.
• All staff had good rapport with patients, they knew their patients and were caring. Staff interactions were positive, caring and kind with patients.
• The service had appointed a dietitian to meet the dietary needs of patients for food choices and meals for diabetes patients.
• The multi-disciplinary team (MDT) treatment reviews were comprehensive.
• The feedback survey from patients was positive and indicated that staff were caring and approachable.

The Care Quality Commission completed an inspection of the services provided by Partnerships in Care Limited (BRAND -Priory Group) as part of our inspection methodology. For this inspection we looked at the registered location, Elm Park in Colchester Essex. This inspection was unannounced, meaning the provider did not have advanced notice of the inspection.

This report describes our judgement of the quality of care at this location. It is based on a combination of what we found when we inspected and a review of all information available to CQC including information given to us from patients, the public and other organisations. For this inspection, we looked at all domains, and have applied ratings to each domain and an overall rating.

Due to the concerns identified during the inspection, we served the provider with nine Requirement Notices in respect of Regulation 9, patient-centred care; Regulation 10, Dignity and respect; Regulation 11, Need for consent; Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 15, Premises and equipment; Regulation 17, Good governance; Regulation 18, Staffing and Regulation 20, Duty of candour.

Updated 31 August 2018

Updated 23 December 2022