Stockton Hall

Updated 7 August 2023

Stockton Hall is a medium secure hospital within the Priory Group. It provides treatment for people aged 18 or over with mental health problems, personality disorders, autistic spectrum disorders and learning disabilities. The hospital admits patients from across the United Kingdom.

Stockton Hall is registered with the Care Quality Commission to provide the following regulated activities:

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

The hospital had a registered manager and a controlled drugs accountable officer in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have the legal responsibility for the service meeting the requirements of the Health and Social Care Act 2008 and associated regulations. A controlled drugs accountable officer is a senior person within the organisation with the responsibility of monitoring the management of controlled drugs to prevent mishandling or misuse as required by law.

The service comprised the following wards:

• Hambleton ward, an 8-bed ward for men with mental illness / co-morbidity.
• Fenton ward, an 8-bed ward for men with autism spectrum disorders
• Kyme ward, a 16-bed ward for men with learning disabilities and co-existing mental illness
• Dalby ward, a 16-bed ward for men with mental illness
• Stonegate ward, a 12-bed ward for women with mental illness and/or personality disorders
• Kirby ward, a 24-bed ward for men with mental illness which was due to close in the next couple of weeks after our inspection
• Castlegate ward, a 12-bed ward for men with mental illness and,
• Farndale ward, a 16-bed ward for men with mental illness.

Castlegate and Farndale wards were due to take the patients from Kirby ward once it closed. Since the last inspection, Boston ward, a 24-bed ward for men with mental illness had closed and Stonegate and Castlegate wards had opened.

The service has been inspected by the Care Quality Commission on 6 previous occasions. The last comprehensive inspection took place 21 to 23 January 2020. The service was rated requires improvement overall; requires improvement under the safe and well led key questions and, good under the effective, caring, and responsive key questions. The service did not comply with 3 of the regulations of the Health and Social Care Act (Regulated Activities) 2014 because:

• There were blanket restrictions in place on all wards that were not necessary to prevent, or not a proportionate response to, a risk of harm posed to or by the patients.

(Regulation 13 Safeguarding service users from abuse or improper treatment).

• The service did not evidence that they had appropriately supported patients to attend to their continence needs while in seclusion.

(Regulation 13 Safeguarding service users from abuse or improper treatment).

• Not all premises and equipment were clean, suitable for the purpose for which they are being used or properly maintained.

(Regulation 15 Premises and equipment).

• The governance systems in place did not provide appropriate oversight. The service did not assess, monitor, and improve the quality and safety of the services provided to patients effectively through their auditing processes as there were multiple administrative errors in documentation.

(Regulation 17 Good governance).

We reviewed whether the provider had made the required improvements during this latest inspection.

Updated 7 August 2023

Our rating of this location stayed the same. We rated it as requires improvement because:

• Some ward areas were not well maintained, well-furnished or fit for purpose. The condition of the wards was not conducive to a therapeutic environment for patients. Most wards had areas requiring updating and furniture that required replacement. The alarm system on most wards was too sensitive, resulting in false alarms.

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• Some seclusion rooms were not fit for purpose. Five out of 9 seclusion rooms we looked at still had no en-suite facilities, so patients had to wait for staff members to take them to an adjacent toilet room. Staff had offered bed pans to patients on Kyme ward or to high-risk patients who could not be taken to an adjacent toilet. Damage incurred to the seclusion room on Kyme ward two weeks prior to our visit, however, we were shown evidence that parts and materials had been ordered to enable the necessary repairs to be completed by the end of July 2023. On Dalby and Kyme wards, there was a lack of natural light in the seclusion rooms and the intercom system on Stonegate ward was faulty.

• Clinic rooms were not always fully equipped or well-maintained. A blood monitoring machine on Stonegate ward had not been subject to quality control since September 2018. The medicines trolley on Kyme ward had not been cleaned and there was a spillage in the medicines fridge.

• The service did not have enough nursing and support staff and staff turnover within the service was high. This had led to patients' activities and Section 17 leave being cancelled at short notice.

• The service's medicines management arrangements were not effective. Insulin had not been labelled to show which patient it related to and, 2 glucose tests had expired in July 2022. On Kirby ward, medicine dispensed in the clinic room had been left there unattended.

• There was no evidence of stool monitoring for a patient on clozapine, an antipsychotic medicine known to cause constipation.

• We found issues in 15 out of 19 care records we looked at. These included staff not adequately documenting that patients had access to occupational therapy or psychological input, standard phrases being copied and pasted in care records, out of date or incomplete care plans and no information about 3 patients' strengths.

• Governance structures were not consistently effective. Processes had failed to identify that staff did not always maintain accurate and up-to-date documentation within care records and blanket restriction registers and medicines management was ineffective within the service. There had been insufficient progress in addressing the environmental issues identified in our inspection in January 2020.

• We saw 2 instances in which patients underwent a pat-down search with the door wide open which compromised their privacy and dignity.

• There were limits to spiritual, religious, and cultural support for patients. Multi-faith rooms were sparse in the way of materials, there was no chaplain in post and patients were using their prescribed Section 17 leave to access places of worship in the local community.

• There were blanket restrictions in place on the ward which were unnecessary. Access to the courtyard and outside spaces at night were dependent on specific circumstances at the time and current staffing arrangements. Access to pool rooms, art rooms and group rooms were restricted because the doors were self-closing with automatic locks, so patients needed a staff member to open them. We found the door to the garden area on Kirby ward was locked and the ward manager told us this was because the grass was being cut but this had already been completed.

• The service did not always engage with carers and relatives well. Three out of 5 carers we spoke with said they had to make efforts to get updates from staff; there was a lack of communication, and their calls were not always returned. One carer told us on multiple occasions, that they had turned up at the hospital for pre-arranged visits with their loved one and staff were not aware of this. Two carers said they did not know how to complain.

However, we found the following areas of good practice within the service:

• Staff had the necessary training, skills, and experience to carry out their roles. They were appraised and received supervision. They adhered to the Mental Health Act and Mental Capacity Act, knew how to report incidents, safeguarding concerns and received lessons learned from investigations into these.

• The teams included or had access to a range of specialists required to meet the needs of patients using the service.

• Patients told us staff were kind, caring, helpful and supportive towards them.

Updated 7 August 2023