St Magnus Hospital and St Magnus Nursing

Updated 16 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place in the nursing service. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 5 inspectors.

Service and service type

St Magnus and St Magnus Nursing is an independent mental health hospital and nursing service registered as a single location. This inspection was carried out in St Magnus Nursing service. People in nursing services receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection of the nursing service of St Magnus.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post overseeing the nursing service.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 9 November 2023 and ended on 12 December 2023. We visited the service on 9 November 2023.

What we did before the inspection

We reviewed information we received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person who used the service and 9 relatives and representatives of people about their experience of the care provided. We observed staff supporting people in the communal areas of the service. We spoke with 20 members of staff including support workers and senior support workers, housekeeping staff, head of housekeeping, nurses, managers, the registered manager, the nominated individual and the director of governance. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with 3 visiting professionals.

We reviewed a range of records. This included 14 people’s care plans, care records and multiple medicines records. We looked at recruitment checks for 3 staff members. A variety of records relating to the management of the service, including governance reports, policies and procedures were also reviewed.

Updated 16 January 2024

About the service

St Magnus and St Magnus Nursing is an independent mental health hospital and nursing service registered as a single location. This inspection was carried out in St Magnus Nursing service comprising of Rosemary Park nursing and Courtyard unit. The nursing service accommodates and provides personal and nursing care to up to 61 individuals across 3 units, East and West Wings of Rosemary Park and Courtyard unit. The nursing service is a part of a highly specialist, national service provided to older people, predominantly men with behavioural and psychological symptoms of dementia, cognitive impairment and/or enduring mental illness. At the time of our inspection there were 49 people using the nursing service of St Magnus.

People’s experience of using this service and what we found

People received person-centred support around their individual risks. Staff knew people’s individual physical, health-related and behavioural support needs. Staff effectively helped people to take positive risks, maintain their abilities and when they became distressed. People’s care plans were comprehensive and tailored to individual needs and risks.

People and their relatives told us they felt the service was safe. Staff knew how to protect people from abuse and neglect. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People, their relatives and representatives were involved in care reviews, asked for feedback and engaged in the service.

There were enough trained and skilled staff to support people. The provider regularly reviewed staffing levels and deployment of staff in the service to ensure staff were able to provide support to people in a timely and safe way. New staff were recruited safely. People received safe support with their medicines provided by trained staff. Staff adhered to good practice around infection prevention and control.

Staff treated people with dignity, respect and kindness. Staff supported people to access healthcare services when needed and communicated with people in a way they could understand. People and their representatives felt comfortable to express their views and told us management would act on their complaints when needed. People could host visitors and staff supported them to engage in a variety of daily activities.

The provider had clear governance and quality assurances systems. Managers completed regular audits of the service and shared key risks, improvement needs and findings within the provider’s organisation. Improvements were made to the service when needed. For example, records, policies and procedures, guidance for staff or environment were reviewed and changed to minimise risks to people and to improve their experience of care.

Staff felt supported and valued by the management. Leaders were visible in the nursing service on a day-to-day basis. People, their relatives and staff told us they were approachable and worked in a transparent way. The culture of the service was calm, welcoming and inclusive, treating each supported person as an individual.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service when we inspected the nursing service and hospital jointly was outstanding (published 16 March 2020). There was no standalone rating awarded for the nursing service at that time.

Why we inspected

We received concerns in relation to safeguarding, staffing and quality of personal care provided to people in the nursing service of St Magnus. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Following that inspection site visit we decided to include the key questions of effective, caring and responsive in this inspection in order to ensure the overall rating for the nursing service only was up to date and reflective of this part of the service.

The overall rating for the nursing service of St Magnus is good based on the findings of this inspection. The overall rating of the hospital remains outstanding as we did not inspect this part of the service on this occasion.

We found no evidence during this inspection that people in the nursing service were at risk of harm from the concerns we received which prompted this inspection. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection of the St Magnus Hospital, by selecting the ‘all reports’ link for St Magnus Hospital and St Magnus Nursing on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Updated 16 March 2020

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. 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 and in line with national guidance about best practice. 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 .

• High performance had been recognised as St Magnus Hospital is a member of the Quality Network for Forensic Mental Health Services (Royal College of Psychiatrists). St Magnus Low secure unit was found to have fully met 92% of standards, putting it in the top ten low secure units in the network.

• 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.

• The service was well - led and the governance processes ensured that ward procedures ran smoothly.

However:

• A small number of staff were allowed to work excessive hours without taking regular days off H andovers did not take place during regular working hours
• The patient bedroom window restrictors were not included in the ligature point audit
• A small amount of equipment was out of date in the clinic room.

Updated 13 January 2016

Updated 16 March 2020

• The ward environment was clean and infection control was well managed. The wards had cleaning schedules and regular audits for cleanliness were undertaken by the housekeeping department.
• We saw clear evidence that all patients were risk assessed on admission and had up to date risk assessments which were linked to their care plans . The staff were exceptional at ensuring that all care plans were personalised, holistic and recovery focused. It was clear from the content of the document that patients and their carers had been involved in developing the plan.
• Use of rapid tranquilisation was low across all wards and staff were using verbal de-escalation skills to ensure that patients’ distress was managed before it required additional medicine
• Staff were clear about their safeguarding responsibilities and knew how to identify and make a safeguarding referral within office hours and during the evening and weekend.
• There were individual and group psychological therapies available to assess and provide treatment In line with national guidance. There was a dedicated psychologist in post to ensure all diagnostic formulation work was happening
• The service invested heavily in trained health care assistants by supporting them to complete the care certificate standards and senior healthcare workers were offered the opportunity to complete their Nurse Associate training funded by the hospital.
• All staff across the service were observed to be exceptionally and consistently caring and respectful to all patients. Staff used thoughtful, appropriate and considerate language and adapted their style of communication to the patients’ level of understanding.
• Carers reported that they felt patients were safe, cared for and well looked after by staff. Staff attitude was described as caring and motivated and carers felt staff went above and beyone to suport tyheir loved ones.
• Staff could give multiple examples of the type of person-centred support that individual patients needed and how they met their needs. Staff were very passionate about their work and it was clear they genuinely cared about the emotional wellbeing of their patients and wanted them to feel cared for. Staff consistently used their in-depth knowledge of the patients to engage with them whilst recognising personal choice.
• The design, layout, and furnishings of the ward/service supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en -suite bathroom and could keep their personal belongings safe.
• The food was of an excellent quality with multiple healthy choices. and patients could make hot drinks and snacks at any time. The patients were complimentary regarding the kitchen’s ability to meet their individual food choices
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.
• Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.
• Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution. Staff reported high morale and were happy in their roles. We observed supportive and cohesive team working and the atmosphere appeared relaxed and encouraging.
• Governance processes operated effectively at ward level and that performance and risk were managed extremely well. All board assurance reports, safety reports and policies were scrutinised by and authorised by the SMT.
• Staff reported multiple opportunities for professional development and that training was appropriate to their needs. This was echoed by the large training department who had already arranged opportunities for mandatory and patient specific training in the next year. Staff reported many opportunity to progress within the service. The culture of developing their own nurses was evident within several of the wards where support workers were being developed to undertake their nurse training.
• Staff confirmed that they received feedback from incidents and complaints and that lessons learnt from other wards was shared with them at team meetings, via emails and within supervision and team days.

However:

• Not all staff had access to the electronic patient record. Junior support workers did not have access to the electronic record and could only view them if a member of staff with access login for them. This meant there was a paper copy of care plans and an electronic copy which required updating every time a care plan was reviewed.
• We found a small number of missed medicine doses that staff had not signed as being given.