Littlebrook Hospital

We found the following issues that the service provider needs to improve:

• The wards were not adhering to Department of Health guidance on same-sex accommodation and patients could not access their rooms independently. One ward had their clinic room incorrectly labelled. Furthermore, one bedroom on Willow Suite did not contain a wardrobe or bedside cabinet.
• The service had a high dependence on bank and agency staff that were unable to access all systems and mandatory training. On one ward staff did not have access to a ward induction.
• The service did not promote a uniform approach to recording information in patients’ progress notes. This made it difficult to follow patient progress during their time on the ward.
• Staff, across all wards, had differing levels of compliance in safeguarding training. The service’s system to escalate safeguarding referrals was ineffective.
• Patients, on one ward did, not have direct access to psychological assessment or intervention. The service was not currently providing the amount of therapeutic activity specified by the Commissioning for Quality and Innovation (CQUIN).
• Patients, on one ward, felt that staff were not approachable.
• The outside areas on Amberwood ward, Cherrywood ward and Willow suite lacked appropriate seating and required attention make them attractive to patients.
• Amberwood ward and Cherrywood ward had limited patient information on display. Patients were not always getting access to advocacy services.

We noted during this inspection that some issues remained in relation to breaches that had previously been identified on our last inspection. However, we also noted the service had made improvements in some of these areas.

• Willow suite was not offering seclusion facilities that provided two way communication or perception of time. However they had changed bedroom allocation which gave women being secluded more privacy and dignity which was an improvement from the last inspection.
• The quality of patients care plans differed across the service. The poorer quality care plans demonstrated that patients were not actively involved in their care. Furthermore, the services approach to care planning meant that patients’ needs were not always identified or monitored regularly. However, since the last inspection improvements had been introduced with a new care plan function on RIO that prompted staff to involve patients, and all staff were now attending care plan training as mandatory.
• The wards did not stock all medicines that were deemed necessary to respond to medical emergencies. Two wards did not appropriately record the temperature of fridges used to store medicines. However, medical equipment was well maintained and checked which was an improvement from the last inspection.
• Detained patients’ Mental Health Act documentation relating to leave and reports carried out by approved mental health professionals was not always available and up to date. However, previous breaches of regulation that related to patients not being informed of rights, patients not been allowed to use leave, and meds given without proper consent forms completed, had all been rectified.

However, we also found the following areas of good practice:

• Patients, staff and visitors had access to appropriate alarms systems that maintained their safety.
• The service had good awareness of the potential impact that high use of bank and agency staff could have on patient care. They had introduced initiatives, such as daily meetings to monitor staffing levels, to reduce this potential risk.
• The service was also introducing a staffing system which would include permanent allied health professionals in staffing numbers. This was expected to significantly reduce the dependence on bank and agency staff.
• Clinic rooms were clean and well maintained with all equipment and medicines checked regularly. The service had robust systems in place to ensure patients medicines were administered correctly; this was reinforced by appropriate support from a pharmacist.
• The service had identified that staff required additional guidance to improve the quality of patients care plans. Care planning training had been made mandatory and all permanent staff had been booked onto this. The service had also added a new function to their electronic patients’ records system which promoted patient involvement in care planning.
• The service had recently introduced a system to improve staffs’ adherence to completing nursing tasks essential to monitoring patients’ mental and physical health.
• Patients felt staff were kind and respectful and would offer them support when required. Furthermore, staff respected patients privacy and always knocked on doors and asked for permission to enter.
• The service was actively looking at ways to effectively discharge people from the service. They had recently introduced a checklist which helped staff identify areas which needed to be addressed or was currently a barrier to discharge.