Arbour Lodge Independent Hospital

We undertook this inspection to find out whether Arbour Lodge Independent Hospital had made improvements to their service since our last comprehensive inspection July 2016.

When we last comprehensively inspected the service in July 2016, we rated the hospital as inadequate overall. We rated safe, effective and well led as inadequate, caring as good and responsive as requires improvement. Following this, we placed the service into special measures.

At this inspection in March 2017, we saw substantial improvement in this service and it has been agreed that the service can exit special measures.

A new governance structure was in place and a permanent registered manager had been appointed. At the last comprehensive inspection in July 2016, five warning notices were issued. We judged the service to have met four of them when we inspected on 17 October 2016 and we judged that the provider had met the fifth warning notice at this inspection. The improvements we had seen in October 2016 had been maintained.

At the March 2017 inspection, we rated Arbour Lodge Independent Hospital as requires improvement overall because:

• The staffing concerns identified at the previous inspection had been addressed, however at this inspection there were concerns that staff were occasionally being allocated to observations for longer than the hospital policy and observation records were not always fully completed.
• Care planning did not always provide enough detail and guidance, for example moving and handling plans and medicines administration. There were however, thorough and detailed assessments and plans for pressure care, nutritional needs and falls risks.

However:

• We received positive feedback from carers and observed positive interactions using the short observation framework tool. Staff knew patients well and had developed good relationships with patients.
• There had been improvements in the responsiveness of the service in terms of pre-admission and discharge planning. 

We rated Arbour Lodge Independent hospital as requires improvement because:

• Support workers who provided the majority of the care to patients and supported them on trips out had not had basic life support training. This means that support workers would not be able to respond to emergency first aid situations with the skills and competence required.

• Only two of the 15 support workers had received training in the Mental Health Act so the majority of the team providing care to patients would not understand their role in relation to the Act.

• Staff were not always following policies for the review of individual risk assessments and observations of patients.

• Staff did not have an appraisal of their performance and documented managerial supervision was not taking place regularly for staff.

• There was no evidence in the care records of physical health examination on admission because all the information in relation to physical health was stored in the GP records. There was no monitoring care plan for patients prescribed medication above the British National Formulary (BNF) limit.

• There was a divide between the nurses and support workers; they had separate team meetings and at handover, nurses did not pass on all relevant information, including changes in presentation of patients and risks.

• Staff did not always give patients copies of their care plans.

• Patients did not receive welcome information on admission or beforehand to describe the hospital environment and what to expect if they stayed there.

• There was no centralised complaints log, staff did not record concerns raised and did not follow the complaints policy.

• Some of the activities offered were not appropriate to the client group and staff did not tailored them to the needs of patients.

• There were no individual hospital objectives and the hospital director had spent months away from Arbour Lodge to provide management cover to other hospitals and care homes.

• There was a high turnover of staff.

• The hospital was not participating in any quality improvement projects or research opportunities.

• Low staff morale had been noted in the support worker team meeting minutes.

However:

Patients and their relatives reported being well cared for and the staff were very respectful. Staff were caring towards patients and we observed warm and encouraging interactions with patients. There was a high attendance at mandatory training. Staff understood the incident reporting policy and followed it. Individual risk assessments were very detailed. Care plans were in place for physical health monitoring and specific needs of patients. Staff felt that managers were approachable.