The Care Quality Commission
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Barchester Healthcare Homes Limited

This is an organisation that runs the health and social care services we inspect

All Inspections

Wednesday 26 and Thursday 27 June 2019

During an inspection of Wards for older people with mental health problems

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.

10 & 11 March 2015

During an inspection of Long stay or rehabilitation mental health wards for working age adults

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.