Archived: The Spinney

Updated 19 October 2016

The Spinney is an independent hospital which is run by the Partnerships in Care group. It is registered to provide the following regulated activities:

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

The hospital provides medium secure, low secure and psychiatric intensive care services for male patients. It has 93 beds split over seven wards. The wards were:

• Shevington ward - a 14 bed medium secure ward
• Hesketh ward - a 15 bed medium secure ward
• Rivington ward - a 16 bed medium secure ward
• Pennington ward - a 10 bed medium secure ward
• Lever ward - a 15 bed low secure ward
• Hindsford ward - a 10 bed low secure ward
• Milford ward – a 3 bed step down ward from the low secure unit
• Hulton ward - a 10 bed psychiatric intensive care unit

All patients were detained under the Mental Health Act. The length of stay varied considerably by ward, with some patients having been admitted for long-term secure care and some new admissions especially on the psychiatric intensive care unit.

The hospital had a registered manager and controlled drugs accountable officer in place at the time of inspection.

We have inspected The Spinney four times since 2010. At the last inspection in October 2015, we found that The Spinney was providing effective services which were well led. We rated care and responsive as outstanding due to the extensive patient and carer involvement initiatives and vocational opportunities. However we rated the safe key question as requires improvement as we found:

• staff did not always complete a risk assessment of patients at admission
• we were concerned about the use of observation lounges on one ward and documentation of this
• staff recorded some instances of seclusion wrongly as long-term segregation
• staff did not always monitor the use of high dose antipsychotic medication in required cases
• staff did not ensure timely review of medication, including duration of treatment and dose required.

We issued requirement notices against regulatory breaches for safe care and person centred care. Following the inspection in October 2015, the provider submitted action plans telling us how they would make improvements. We reviewed the action plans submitted by the provider. On this inspection, we found that those improvements had been made. We found the provider had taken action to address the requirement notices. This meant we were able to re-rate the provider at this inspection as we found they had taken sufficient action to ensure all areas of concern had been addressed and no new regulatory breaches were found.

We have reported on forensic/inpatient secure wards and the Psychiatric Intensive Care Unit (PICU) together within this report due to the relatively low number of beds within the psychiatric intensive care unit.

Updated 19 October 2016

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We conducted this unannounced focused inspection to review two requirement notices given at our last comprehensive inspection in October 2015. We published our inspection report in February 2016. The requirement notices related to the safe key question which we rated as requiring improvement due to breaches of regulation 9 - person-centred care and regulation 12 - safe care. Following the inspection in October 2015, the provider submitted action plans telling us how they would make improvements. This also covered areas where we had made recommendations.

We inspected The Spinney on 10 and 15 August 2016 to check whether these improvements had been made. We visited all the forensic wards and the psychiatric intensive care unit. We found areas of good practice:

• Managers in the hospital had taken sufficient action to address the requirement notices we issued following the inspection in October 2015.
• Staff completed risk assessments of patients at admission and on an ongoing basis.
• There were new protocols to guide staff on de-escalating patients’ disturbed behaviour in the observation lounges.
• Staff and managers monitored the use of high dose antipsychotic medication.
• There were improved medicine management arrangements with reviews of medicines prescribed 'as required'.
• Wards were clean, well maintained and ligature risks were managed.
• Staffing levels were safe with low levels of sickness and agency use.
• Staff received appropriate mandatory training.
• There were low levels of restraint and where restraint had been used it was monitored by managers.
• There were appropriate lessons learnt following incidents.

As managers at The Spinney had made the improvements within six months from the date of publication of the last report, we re-rated the safe key question from requires improvement to good. Using our aggregation principles, this also led to an overall rating of outstanding for The Spinney as the caring and responsive key questions were previously rated as outstanding and all other key questions rated as good.

However, we also found some areas for improvement:

• Patients on Rivington and Lever wards were subject to restrictions on accessing their bedrooms due to the ward layout. Managers were addressing these restrictions.
• There were small number of delays in doctors attending episodes of seclusion out of hours on Hulton ward and the long-term segregation policy required amendment about our role.
• A small number of patients on high-dose antipsychotics regularly refused health checks and there was limited recording of the benefits and risks of continuing with the regime.
• On some wards, the written ward ligature risk assessment was not readily available to all staff.

Updated 19 October 2016