The Copse

Updated 1 June 2022

The Copse is a long stay rehabilitation service that takes patients over the age of 18 with enduring mental health problems. The service aims to support patients to work towards recovery and transition to a less restrictive environment or community setting. Patients may be admitted from acute wards, low secure settings or directly from the community.

The hospital has 24 beds and is split into four, six bedded wards, three for men and one for women.

The service is registered to provide the following regulated activities:

Treatment of disease, disorder or injury

Assessment or medical treatment for persons detained under the Mental Health Act 1983

Diagnostic and screening procedures.

The service did not have a registered manager. The newly appointed hospital director was in the process of applying to be registered manager.

We undertook this unannounced comprehensive inspection of The Copse following concerns identified at our last inspection. Concerns had also been raised with us by former patients, carers and staff.

A focused inspection of the safe and well-led domain for this service took place in August 2021. Following this inspection, the service was rated requires improvement in both domains. We found that the service was not fully meeting the required standards of care of Regulations 12 (safe care and treatment), 13 (safeguarding services users from abuse and improper treatment), 17 (good governance) and 18 (staffing) of the Health and Social Care Act (regulated activities) Regulations 2014. We served 10 requirement notices and told the service it must take action to improve risk management, medicines management, use of restrictive interventions, training compliance, documentation, safeguarding and ensure there were enough suitably qualified staff to meet patients’ needs.

The last comprehensive inspection of the service took place in July 2019. The service was rated good in all domains and overall.

What people who use the service say

Patients and carers told us that the hospital had been overly restrictive in response to the coronavirus pandemic. Patients and carers felt that meaningful activities and therapies had reduced since the start of the pandemic.

However, patients felt there had been some recent improvements since coronavirus restrictions had been stopped and new activities and community trips organised.

The majority of patients told us that there was enough staff to meet their needs and staff treated them with kindness. Patients told us that they felt involved in their care, and decision-making that impacted them.

Updated 1 June 2022

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

• Staff did not always feel safe on the wards and did not always adhere to policies and risk management plans to keep themselves and others safe. Staff felt there weren’t enough staff to respond and provide support in an emergency. Managers had not ensured the environment was safe and that staff were aware of interventions to mitigate identified risks. Staff did not manage medicines safely and there were repeated medicine incidents.
• The service’s reducing restrictive practice programme was only partially embedded. Managers did not fully assess the negative impact of restrictive practice on patients and take steps to reduce this as far as possible. Patients told us they could not access the garden except at allocated smoking times.
• Staff did not always understand the individual needs of patients or support them to manage their own care and treatment. Staff did not always respect patients’ privacy and dignity. Patients told us that not all staff treated them with kindness and respect.
• Staff had not received specialised training required to meet the rehabilitation and recovery needs of patients. They were not working within the specified model of recovery and utilising best practice assessment and outcome tools routinely. Staff did not develop recovery oriented and person-centred care plans in response to assessments that were completed. The service did not have an occupational therapist in post and during the coronavirus pandemic the range of treatments, activities and therapies on offer had significantly reduced.
• Patients had limited opportunities to engage with the wider community. Carers and families did not feel involved in patient care and felt that communication from the service was poor. Staff did not develop comprehensive discharge plans and it was therefore unclear how staff were working with patients towards meaningful recovery and discharge into the community.
• Managers did not have a clear understanding of the expected length of stay for patients. There was a lack of governance processes in place to monitor how clinically effective the hospital was.

However:

• There had been significant improvements in the individual risk assessment and management of patients since our previous inspection in 2021. Patients had positive behavioural support plans in place, and assessment and management of risk was more comprehensively discussed at multidisciplinary reviews. Staff recognised incidents and reported them appropriately. Staff followed safeguarding processes, took action to protect patients from abuse, and worked well with other agencies to do so.
• Managers had ensured that mandatory training compliance had improved. Although there were vacancies within the staff team, the number of shifts that did not meet planned staff requirements had reduced in the previous three months.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff felt confident to raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients.
• The occupational therapy assistants were proactively working to increase engagement with the wider community and organising activities within the community. Over the previous month activities in the community had been restarted and some patients were engaging in internal employment and volunteer opportunities.
• There was a new leadership team who had a clear plan in place for the site and had started to make progress. Although new processes had not had time to be embedded as yet, the new hospital director was aware of the risk areas and performance issues facing the service. They had reviewed the site improvement plan and had developed this in response to the identified areas for improvement, and progress with this was already evident. Staff said there had been a positive shift in culture.

Updated 1 June 2022

• Staff did not always feel safe on the wards and did not always adhere to policies and risk management plans to keep themselves and others safe. Staff felt there weren’t enough staff to respond and provide support in an emergency. Managers had not ensured the environment was safe and that staff were aware of interventions to mitigate identified risks. Staff did not manage medicines safely and there were repeated medicine incidents.
• The service’s reducing restrictive practice programme was only partially embedded. Managers did not fully assess the negative impact of restrictive practice on patients and take steps to reduce this as far as possible. Patients told us they could not access the garden except at allocated smoking times.
• Staff did not always understand the individual needs of patients or support them to manage their own care and treatment. Staff did not always respect patients’ privacy and dignity. Patients told us that not all staff treated them with kindness and respect.
• Staff had not received specialised training required to meet the rehabilitation and recovery needs of patients. They were not working within the specified model of recovery and utilising best practice assessment and outcome tools routinely. Staff did not develop recovery oriented and person-centred care plans in response to assessments that were completed. The service did not have an occupational therapist in post and during the coronavirus pandemic the range of treatments, activities and therapies on offer had significantly reduced.
• Patients had limited opportunities to engage with the wider community. Carers and families did not feel involved in patient care and felt that communication from the service was poor. Staff did not develop comprehensive discharge plans and it was therefore unclear how staff were working with patients towards meaningful recovery and discharge into the community.
• Managers did not have a clear understanding of the expected length of stay for patients. There was a lack of governance processes in place to monitor how clinically effective the hospital was.

However:

• There had been significant improvements in the individual risk assessment and management of patients since our previous inspection in 2021. Patients had positive behavioural support plans in place, and assessment and management of risk was more comprehensively discussed at multidisciplinary reviews. Staff recognised incidents and reported them appropriately. Staff followed safeguarding processes, took action to protect patients from abuse, and worked well with other agencies to do so.
• Managers had ensured that mandatory training compliance had improved. Although there were vacancies within the staff team, the number of shifts that did not meet planned staff requirements had reduced in the previous three months.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff felt confident to raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients.
• The occupational therapy assistants were proactively working to increase engagement with the wider community and organising activities within the community. Over the previous month activities in the community had been restarted and some patients were engaging in internal employment and volunteer opportunities.
• There was a new leadership team who had a clear plan in place for the site and had started to make progress. Although new processes had not had time to be embedded as yet, the new hospital director was aware of the risk areas and performance issues facing the service. They had reviewed the site improvement plan and had developed this in response to the identified areas for improvement, and progress with this was already evident. Staff said there had been a positive shift in culture.