St Neots Neurological Centre

St Neots Hospital provides long stay and rehabilitation wards for adults with severe and enduring mental health needs. It specialises in caring for patients with complex and co-morbid mental health and physical health conditions, including progressive neurological conditions and patients in the latter stages of their diagnosis.

We carried out this unannounced inspection as a follow up to a focused inspection that took place July 2020 and to review those parts of the service that did not meet legal requirements at that visit. We also carried out this inspection as we had received a number of recent whistleblowing concerns from staff at the hospital.

At the previous inspection we did not rate this service. The most recent comprehensive inspection was completed in August 2019 when we rated this service as good in all areas.

St Neots Neurological Centre provides long stay and rehabilitation wards for adults with severe and enduring mental health needs. There are 4 wards in the hospital on the same site Willow, Cherry, Rowan and Maple.

We rated it as requires improvement because:

• There were no cleaning records for the clinic room and no cleaning records for clinical equipment, so no evidence to show that these areas and equipment were being cleaned regularly between patients.
• Risk assessments for patients moving into the hospital often took a few months to be written and added to the computer system.
• The hospital had not followed procedures after rapid tranquillisation for one patient. We were not able to find records to show that the patient had been observed afterwards and that the doctor had been informed.
• Clinic rooms had out of date dressings and the grab bag had items not stored correctly.
• Patients did not all have a discharge plan where appropriate.
• The inspection team witnessed 2 staff speaking to each other in their first language in front of patients and not all staff were wearing name badges.
• Care plans did not include spiritual needs for some patients who were at end of life.
• Staff training was not at an acceptable compliance level of 75% on 6 occasions.
• Staff did not always follow the hospital medication policy and procedure when recording medication.
• It was not clear in one patient’s prescription chart and care plan who had several medications for the same mental health condition, when to use which.
• The restrictive hospital environment resulted in patients sharing communal bathing facilities and quiet areas were limited.

However:

• The service had enough nursing and medical staff, who knew the patients and received good training to keep people safe from avoidable harm. Staff on shift and on induction told us that the training they received by the hospital was very thorough and there was a comprehensive training programme for additional non mandatory training, which all staff could access. Managers used a training matrix to record mandatory training and used a traffic light system to alert managers when training had not been completed.
• Staff assessed and managed risks to patients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients’ recovery. We observed a planned restraint, the patient was treated with dignity and respect, given choices and the process was well managed from start to end and staff avoided restraint using de-escalation techniques.
• Staff told us each staff member had a password to access patients records, regular agency staff had a password and temporary agency could access the system using a one-time password.
• Staff told us they received a debrief after serious incidents, this happened every morning at the hand over meeting. Carers told us managers investigated incidents promptly and thoroughly.
• Staff discussed recent incidents during team meetings and lessons learnt posters were displayed on a quarterly basis in the hospital and in reception areas and included actions taken.
• Staff managed physical health efficiently including using The National Early Warning Score to record any changes in patients' well being and assessed the physical and mental health of all patients on admission.
• Care plans were holistic, goal orientated and reflect change. Care plans included physical and mental health, moving and handling, medication, finances and end of life plans, nutrition and communication. Each patient had a different person-centred model of care and a Meaningful Care Plan. Care plans were reviewed regularly through multidisciplinary discussion and updated as needed.
• The hospital had a full multidisciplinary team 1 consultant neuropsychologist, 2 occupational therapists, 1 assistant psychologist, 1 physiotherapist, 1 social worker, 1 speech and language therapist and 4.6 therapy assistants. The therapy team were able to provide a full range of activities and therapies both in the ward and in the community.