Ellern Mede Moorgate Also known as Oak Tree Forest Limited

Updated 24 April 2024

Ellern Mede Moorgate is a hospital run by Oak Tree Forest Limited. It provides specialist eating disorder inpatient services for children and young adults. The hospital was registered in September 2019 and provides treatment for up to 12 patients, both male and female. It has two six-bed wards. Inca ward is for young people aged 8 to 18 and Aztec ward is for young adults aged 18 to 25. The hospital offers treatment to patients with complex eating disorders and can support patients who require nasogastric feeding. The hospital has an on-site school to provide patients with an education during their admission. At the time of our inspection, the hospital had a registered manager who was also the nominated Controlled Drugs Accountable Officer (CDAO).

The service is registered by the CQC to provide the following registered activities:

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

• Treatment of disease, disorder or injury.

The service has been inspected three times previously since it opened. The last time was in May 2023 where we carried out a comprehensive inspection. Following this inspection the provider was rated as requires improvement overall with breaches of Regulation 9 (Person-centred care), Regulation 17 (Good governance) and Regulation 18 (Staffing). We did not find that these issues had been resolved during this inspection, including continued staffing concerns, overuse of restrictive practices, lack of access to psychological therapies and concerns relating to the provider’s governance and quality monitoring systems.

We undertook this inspection of Ellern Mede Moorgate due to concerns received about the quality of care and the safety and wellbeing of the young people using the service. We carried out an unannounced comprehensive inspection of all key questions.

What people who use the service say

The people we spoke with told us that the hospital was usually clean and tidy, with no significant environmental issues. People told us there was not much to do, with very few activities ever taking place. People said there was often not a lot of staff around and they could go a whole day without speaking to anyone. Some young people also said the night staff were rude to them. The young people we spoke with said they did not always feel safe at the hospital because physical restraint was used a lot and people told us they had been injured during restraints. People raised concerns about the lack of psychological therapies to support their recovery. People told us that they did not feel involved in their care, or their discharge plans and they did not have a copy of their care plan. Carers told us that they felt their relative was safe at the hospital and that the visiting rooms were clean and appropriate for their needs. Some carers told us they did not always feel well informed about or involved in their relative’s care. Carers told us that they were able to give feedback about their experience, but they did not always feel assured that improvements would be made if they raised concerns.

Updated 24 April 2024

Our rating of this location went down. We rated it as inadequate because:

• The service did not provide safe care. The wards did not have enough nurses and reliance on agency workers was high. Staff did not always assess or manage risk well and incidents causing harm to people using the service occurred during our inspection. Staff did not minimise the use of restrictive practices and people using the service told us about the negative impact this had on them.
• The service did not provide a full range of treatments suitable to the needs of the patients or in line with national guidance about best practice. We observed care being delivered which did not align with nationally recommended practice for the treatment of eating disorders. People using the service were not receiving adequate psychological therapies to support their recovery. Relatives and stakeholders had raised concerns about some people not progressing during their admission. Due to the staffing pressures and the complex needs of the patients, staff did not have the capacity to adequately engage in clinical audit to evaluate the quality of care they provided.
• Managers did not consistently ensure that staff received adequate training, supervision or appraisal. Staff did not always engage effectively with those outside the ward who would have a role in providing aftercare.
• Staff did not always treat patients with compassion and kindness, respect their privacy and dignity, or understand their individual needs. Staff did not consistently involve patients and their families in care decisions.
• People told us that they felt bored and that there was little to do at the hospital. We did not observe many organised activities taking place during our inspection.
• Admissions and discharges were not always managed well, which resulted in additional pressures on the ward staff.
• Governance processes did not identify some of these significant shortfalls in the care provided at the hospital and staff did not feel well supported by senior managers.

However:

• The ward environments were safe and clean.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• People were receiving meaningful support from the dietetic team.
• Senior managers had started a number of improvement projects including the creation of patient inclusion lead and autism champion posts

Letter from the Interim Chief Inspector of Adult Social Care and Integrated Care, James Bullion:

I am placing the service into special measures. 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 take action 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.

A final version of this report, which we will publish in due course, will include full information about our regulatory response to the concerns we have described

Updated 24 April 2024

Our rating of this service went down. We rated it as inadequate. See summary above for details.