Cotswold Spa Hospital

Updated 10 November 2021

We carried out this inspection of Cotswold Spa in line with our inspection methodology for newly opened services. The hospital was taken over by Elysium in September 2020.

The hospital has 12 beds for adults and young people and provides a day care facility for three further patients. Adults and young people have separate ward areas.

The service offers treatment to young people with an eating disorder diagnosis between the ages of 13 and 25. The hospital accepted patients of all genders but at the time of our inspection there were only female patients. Nine of the 12 inpatients were under the age of 18.

The hospital provided the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder or injury.
• Diagnostic and screening procedures.

At the time of our inspection there were 12 patients in the hospital and three patients accessing day care. The hospital manager, who was the registered manager was in an interim role. The hospital planned to recruit a permanent hospital director.

What people who use the service say

We spoke to three patients at the hospital, the other patients declined to speak to us. However, we also received six comments cards

Patients’ feedback was mixed. Some feedback was positive, that staff were kind, patients felt safe, the hospital was clean, and patients were happy with the environment. Three patients said not all staff had always been respectful in their interactions with them. However, one of these patients said that when they brought up concerns about this they were dealt with effectively and immediately. Three patients told us they felt the service could provide more for patient’s psychological issues.

Two patients and their families said there had been several agency staff employed and there had not always been a good gender balance in the staff team because there were too many male staff on shift. This had been anxiety provoking for patients. However, the provider does not employ agency staff and uses regular bank staff and the current staff team was in the main made up of female staff.

We spoke to the families and carers of seven patients. Their feedback was mixed, but overall, they were happy with way their family members were treated. They described staff as kind and caring. They were happy with the hospital environment and thought it was clean. Most families and carers said their family members were making progress and were safe. Overall, they either told us the service was improving or the issues they raised with us had been resolved by the hospital. Parents were able to attend Care Programme Approach reviews and ward round meetings.

The concerns raised by three families were like those raised by patients. Families raised concerns about recent staff turnover and the high use of agency staff earlier in the year. Three parents did not think there was enough available therapy in the absence of a psychologist. Two parents said the hospital staff did not always communicate effectively.

Updated 10 November 2021

Cotswold Spa hospital provides a specialist inpatient eating disorder service for children, young people and adults aged 13-25 years. Patients are routinely funded by the NHS but can be privately funded. Cotswold Spa was taken over by Elysium Healthcare in September 2020. Prior to this it was owned by another provider.

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

• The service provided safe care. The ward environments 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.
• Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• 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.
• Staff planned and managed discharge well and liaised well with services that could provide aftercare.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• There was no clinical psychologist at the time of our inspection. The provider had recruited to a permanent position but was not starting until December. The service had specialist support from other services and the existing multidisciplinary team were able to offer therapeutic interventions.
• Family and patient feedback was mixed and there were some issues raised by families and carers. However, at the time of our inspection we found that the hospital had made progress in respect of the concerns that patients and families and carers had made.
• The consultant psychiatrist and ward doctor were not up to date with their immediate life support training at the time of our inspection.
• There was an interim hospital manager, who was the registered manager at the time of our inspection and a locum consultant psychiatrist, the hospital had not yet recruited permanent staff to these roles.

Updated 10 November 2021

Please see summary at the start of this report