15, 16, 17 January 2024
During a routine inspection
Our rating of this location went down. We rated it as inadequate because:
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We have taken enforcement action against the provider to make sure they improved their governance systems. This normally limits the rating for that key question to inadequate.
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The service was not always well led and the governance processes did not always ensure that ward procedures were effective. There were gaps in governance processes that failed to identify areas of concerns.
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The service did not provide safe care. It did not manage medicines, medicine fridges and medical supplies safely and risk assessments were not always complete. Medicine records were found to have been filled in retrospectively by staff when gaps were identified at our inspection. Prescribed medicines were not always in stock and available and that accurate records of medicines were not always made. Medicines were not always lawfully prescribed prior to administration.
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The service was using both a paper and electronic records system, we found that paper records did not contain the most up to date risk assessments for people in 4 out of 4 records we reviewed on Adarna ward.
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Staff on Adarna ward were not all bare below the elbow in accordance with the provider’s own policy.
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The environment was not always clean, we found food on the floor, staining on furniture, cigarette ends in the lounge and some of the furniture was ripped.
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Staff on Adarna ward did not always understand the individual needs of people. They did not always actively involve families and carers in care decisions. Care plans on Adarna ward did were not always of sufficient quality and detail to meet the needs of people
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Physical health was not always managed safely on Adarna ward in respect of bowel monitoring, particularly for people taking medication that caused a risk of bowel obstruction.
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The ward environment on Adarna ward was still too noisy and steps taken to reduce the level of noise for people since our last inspection had not been fully effective.
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On Adarna ward Staff restricted people’s access to items on the ward and this was not always based on individual needs.
However:
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There was enough staff working on the wards to keep people safe with low levels of vacancies. The wards had enough nurses and doctors. Staff followed good practice with respect to safeguarding and complaints. Use of restrictive practices was minimised.
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Mandatory training compliance rates were high and managers had oversight of when training was due to be renewed.
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Staff provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
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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.
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Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
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Staff treated patients with compassion and kindness, respected their privacy and dignity.
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Therapeutic activities took place and people described things they enjoyed doing both on and off the ward.
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Staff worked well with external stakeholders and professionals to support people’s discharge plans.
Letter from the Chief Inspector of Healthcare, Dr Sean O’Kelly:
"I am placing the service into special measures. This is because the service has had two inadequate ratings against any key question on two consecutive inspections. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration."