Barchester Healthcare Homes Limited

Updated 4 September 2019

Castle Lodge independent hospital is a specialist independent mental health service based in Kingston-Upon-Hull. It is part of the Barchester hospital and complex care services division. Providing services for men with an organic diagnosis, a type of illness usually caused by disease affecting the brain, and women with a functional diagnosis, a type of illness that has a mainly psychological cause, on an informal and a detained basis. The hospital accommodates up to 15 patients.

The hospital is registered with the Care Quality Commission to carry out two regulated activities:

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

At the time of our inspection, there was a registered manager who was also the controlled drugs accountable officer for the hospital in post.

The Care Quality Commission has inspected Castle Lodge independent hospital seven times; the last inspection was an unannounced follow up inspection that took place in January 2017.

At the last inspection, we rated the hospital overall as ‘good’. We rated the service as ‘requires improvement’ for Safe, ‘good’ for Effective, ‘good’ for Caring, ‘good’ for Responsive and ‘good’ for Well-led.

Following that inspection, we told the provider that it must take the following actions to improve Castle Lodge Independent Hospital:

• The provider must ensure safe systems in the management of medicines.
• All staff involved in dispensing medication must be familiar with and work to hospital protocols. Pharmacy systems must be robust, and the provider must ensure that medication audits are effective with learning from these shared.
• Hospital staff must ensure the correct quantities of all medications are available, so each patient has sufficient to meet their needs.
• The provider must ensure that the administration of covert medication is only agreed following consultation with a pharmacist and regularly reviewed in multidisciplinary team meetings.
• The provider must ensure that medicines for disposal are appropriately stored and disposed of in a timely way.
• New medication and device safety alerts must be cascaded to nursing staff in a timely manner.

We also told the provider that it should take the following actions to improve Castle Lodge Independent Hospital:

• The provider should ensure enough qualified, competent and skilled staff to meet the needs of the patients. This includes sufficient qualified nurses on duty to complete the professional oversight required, a consultant psychiatrist is able to attend the hospital in the event of a psychiatric emergency within 30 minutes and gaps in the appointment of key staff are kept to a minimum.
• The provider should ensure that following assessment of a patient’s capacity to consent the documentation available to record this is fully completed and that the opinions of a patient’s family or advocate are recorded in best interest meeting notes within patient files.
• The provider should ensure that patients maintain as much independence as is possible. This includes having everything they need to participate fully in an activity, for example reading glasses, to be able to access all areas of the ward and gardens independently and when possible being able to make their own drinks and snacks.
• The provider should ensure that dirty linen trollies remain stored away from patient areas.

We issued the provider with one requirement notice, this related to:

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

The provider submitted an action statement setting out the steps they would take to meet the legal requirements of the regulations. We reviewed the requirement notices at this inspection and found that the hospital had addressed the actions agreed in relation to the breach and the shoulds.

Updated 4 September 2019

Updated 14 May 2015

Forest care home staff from the same site  had been used in emergencies on the hospital unit due to short staffing. This had caused confusion amongst staff about the differences between the care home and hospital. There had been a recruitment campaign with many new starters taking up post. Induction programmes were in place. However these were not effective because staff had not completed all the programme, or had to deal with situations before policies and procedures had been read and consolidated. For example, staff told us they had not seen the observational or complaints policies. Staff were not provided with performance information or action plans arising from audits and incidents. The lack of information meant that there were no team objectives. Appraisals, managerial and clinical supervision were not being undertaken regularly. Staff told us they had not received specialist training in caring for people with Parkinson’s and Huntington’s disease, which the hospital were providing specialist care for. We found that there was a lack of leadership being provided at clinical and senior management level.

Admission criteria were not used during pre-assessment to admit patients. The hospital's purpose was to provide rehabilitation, however the case mix resembled continuing care. There was no collective decision making about admissions and inpatients care as the psychiatrist, psychologist, occupational therapist (OT) visited on different days and did not have multi-disciplinary meetings.

On the day of our visit, newly recruited nurses were in charge with inadequate supervision. The nurses had not been inducted to use the defibrillator. The sign for the first aider was out of date. Not all staff had alarms to summon help. There were confusing medication protocols for giving medication as required (PRN). At one stage of our visit the nurse left the ward with the keys to the clinic room which contained the medications and resuscitation equipment. A “general services association system” was used to manage violence and aggression; The company had changed to the use of the management of actual or potential aggression (MAPA) in 2014. However not all staff at the hospital were trained in this. This meant that there was a mixture of approaches being used  which placed patients at risk of injury with differing techniques being used.

Physical health assessments were not clearly recorded. We found records where personal care had not been signed for. Activities were not actively promoted; the activities programme was out of date on the board. There was a lack of involvement of carers and patients in care plans. “This is me “and “about you “plans were not fully completed. Communication tools and easy read literature were not available. There were limited menu choices available. There were no audit records of the number of hospital appointments that had been cancelled.

The number of incidents, safeguarding alerts and complaints were low. There was no assurance that all that needed reporting was reported. The reporting systems from the ward to the board and from the board to the ward were weak. This meant that there was no early warning to the board that things may not be right. It also meant the team were not receiving information that could help them improve the service.

We found that the hospital was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (the Regulated Activities Regulations 2010)  for regulations 13, 20,22 and 23 and have issued compliance actions. We also issued warning notices for breach of regulation 9 and 10.

We will consider these regulations within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that come into force on 1 April 2015 in our follow up inspections.

Updated 4 September 2019

We rated Castle Lodge Independent Hospital as good because:

• The service provided safe care. The ward environments were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices but when necessary they reported, reviewed and learnt lessons from any incidents.
• The service managed medicines safely, involved patients where possible in all decisions and followed good and clear procedures when covert medications were required.
• The service followed good practice with respect to safeguarding and had an effective working relationship with the safeguarding team.
• 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.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those external to the ward.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005 and made every effort to involve patients in decisions about their care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and fully understood the individual needs of patients considering their background, work history, likes and dislikes and by engaging with people in their lives.
• They actively involved patients and families and carers in care decisions and kept families fully informed when incidents occurred.
• Staff viewed complaints positively and encouraged feedback to improve the service and outcomes for the people who used it.
• The service was well led and the governance processes ensured that ward procedures ran smoothly.
• Leader were visible in the service and well known, they took the time to understand individual needs and encouraged innovative practice to deliver the best outcomes.
• Staff and services were recognised, valued and rewarded for delivering high quality care.

However:

• The provider should ensure there are sufficient qualified nurses on duty at all times in order to meet patients’ needs.
• The provider should ensure that patients could have free access to outdoor space and lockable bathroom doors.
• The hospital should ensure cleaning records are completed and kept up to date.
• Improvements were required to enhance the environment for people living with dementia.