NAViGO Health and Social Care CIC

Updated 11 December 2019

Navigo Health and Social Care Community Interest Company is a non-profit making organisation providing all local mental health and associated services in North East Lincolnshire. 

The population of North East Lincolnshire is approximately 170,000 and areas within the authority rank within the 10% most deprived areas of England. 

Navigo is registered to provide the following: 

• Transport services, triage and medical advice provided remotely 
• Treatment of disease, disorder or injury 
• Diagnostic and screening procedures 
• Assessment or medical treatment for persons detained under Mental Health Act 1983. 

It provides the following services: 

• Acute wards and community services for adults of working age  
• Older People inpatients and community services (including admiral nurses) 
• Long stay rehabilitation services for adults of working age  
• Crisis resolution and home treatment services 
• Health based place of safety 
• Eating disorder services 
• Forensic community services 
• Early intervention services 
• Personality disorder community services 
• Housing and rehabilitation 
• Family therapy 
• Volunteer opportunities 

Updated 11 December 2019

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

• We rated well-led at the provider level as good.
• Managers at all levels had the right skills and abilities to run a service providing high-quality sustainable care.
• Senior operational roles had business as well as operational roles and responsibilities. They demonstrated understanding of their areas of expertise.
• Navigo’s strategy was aligned with the local sustainability and transformational plans and integrated care partnerships. They regularly monitored their progress.
• Staff felt respected, supported and valued and were positive about working for the provider. This was evident from the core services reviews that we undertook and also the staff and service user focus groups.
• Staff and service users were treated with dignity and respect, at times offering support outside of their commissioned services.
• Navigo practiced value-based recruitment and service users were always involved in the recruitment process.
• Navigo recognised members’, staff and volunteers’ achievements. In June 2019 they held their first volunteers and members award ceremony and held regular staff award events.
• Navigo had a well embedded governance structure.
• The provider reported no never events since our last inspection.
• Safeguarding governance structures were current and formed part of the providers quality agenda.
• Navigo had centralised clinical dashboards that were available at all levels including to the board and to service areas; these were usually reported on quarterly to the board, however this data could be viewed daily.
• Navigo had the 12th highest response rate for the NHS staff survey of all NHS providers; they scored in the top 10% of all provider trusts in 11 of the 32 key areas.
• Navigo was involved in numerous national research projects.
• Navigo was involved in some innovative projects for staff, members and service users.

However:

• The long stay rehabilitation service we inspected was rated as requires improvement in both the safe and well led domain.
• In both core services we found that the provider did not have a policy on ligature risk or a comprehensive fire policy.
• Two bank staff member had not completed any mandatory training.
• Some medicine cards had gaps on them.
• In the rehabilitation service, not all incidents were reported and acted upon in a timely manner.

Updated 15 February 2018

This was the first time we have inspected the eating disorders service.

We rated it as outstanding because:

Navigo Health and Social Care CIC provides a specialist eating disorder service for adults with complex eating disorders called Rharian Fields. The inpatient ward admits patients detained under the Mental Health Act 1983 and those admitted informally. It provides assessment, treatment and rehabilitation to patients who require a hospital admission due to their eating disorder. The service has an aftercare, outpatient provision, which patients who live locally can access once discharged from the ward into the community. There is also a day patient service, which sees patients in the community.

The ward has eight beds available for both men and women. The ward is situated on a site within the grounds of the county’s general hospital. Rharian Fields accepts privately funded patients as well as patients funded by the NHS across the United Kingdom.

At the time of our inspection, there were six patients allocated to the ward. All patients were female and there were no patients detained under the Mental Health Act. The outpatient provision was not currently required as there had been no local patients discharged recently. The community day patients’ service was located away from the inpatient ward at NAViGO House, and was not part of this inspection.

We have not inspected this service before and this inspection was unannounced.

To understand the experience of people who use services, we always ask the following five questions of every service and provider:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

Before the inspection visit, we reviewed information that we held about these services, asked a range of other organisations for information and sought feedback from patients and carers at focus groups.

During the inspection visit, the inspection team:

• visited the ward and looked at the quality of the environment
• attended and observed a clinical review, handover, group therapy session and a lunchtime experience
• spoke with three patients who were using the service
• spoke with three carers of patients using the service
• spoke with the registered manager and the ward manager
• spoke with seven other staff members including the consultant, the psychologist, the dietitian, nurses and nursing assistants
• collected feedback from patients and carers using comment cards
• looked at five care records of patients
• looked at six prescription cards of patients
• carried out a specific check of the medication management
• looked at policies, procedures and other documents relating to the running of the service.

Updated 14 February 2017

We rated community-based mental health services for older people as good overall because:

• Following our inspection in January 2016, we rated the service as good for effective, caring, responsive and well-led.

• During this most recent inspection, we found that the service had addressed the issues that had caused us to rate safe as requires improvement following the January 2016 inspection.

• The community-based mental health services for older people were now meeting Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Updated 15 February 2018

This was the first time we have inspected the eating disorders service.

We rated it as outstanding because:

Navigo Health and Social Care CIC provides a specialist eating disorder service for adults with complex eating disorders called Rharian Fields. The inpatient ward admits patients detained under the Mental Health Act 1983 and those admitted informally. It provides assessment, treatment and rehabilitation to patients who require a hospital admission due to their eating disorder. The service has an aftercare, outpatient provision, which patients who live locally can access once discharged from the ward into the community. There is also a day patient service, which sees patients in the community.

The ward has eight beds available for both men and women. The ward is situated on a site within the grounds of the county’s general hospital. Rharian Fields accepts privately funded patients as well as patients funded by the NHS across the United Kingdom.

At the time of our inspection, there were six patients allocated to the ward. All patients were female and there were no patients detained under the Mental Health Act. The outpatient provision was not currently required as there had been no local patients discharged recently. The community day patients’ service was located away from the inpatient ward at NAViGO House, and was not part of this inspection.

We have not inspected this service before and this inspection was unannounced.

To understand the experience of people who use services, we always ask the following five questions of every service and provider:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

Before the inspection visit, we reviewed information that we held about these services, asked a range of other organisations for information and sought feedback from patients and carers at focus groups.

During the inspection visit, the inspection team:

• visited the ward and looked at the quality of the environment
• attended and observed a clinical review, handover, group therapy session and a lunchtime experience
• spoke with three patients who were using the service
• spoke with three carers of patients using the service
• spoke with the registered manager and the ward manager
• spoke with seven other staff members including the consultant, the psychologist, the dietitian, nurses and nursing assistants
• collected feedback from patients and carers using comment cards
• looked at five care records of patients
• looked at six prescription cards of patients
• carried out a specific check of the medication management
• looked at policies, procedures and other documents relating to the running of the service.

Updated 11 December 2019

We have not inspected this service before. We rated it as requires improvement because:

• Our findings from the key questions demonstrated that the service did not always provide safe care and did not always have effective governance processes to manage and mitigate risk sufficiently.
• Brocklesby Lodge could and had been easily accessed by patients from the health-based place of safety. Apart from recording this on the risk register, managers had not taken any action taken to try to prevent this from happening again.
• The service required further development to ensure it followed a recognised model for rehabilitation care. The service operated without a registered nurse on shift at night which was not in line with the essential requirement set by the Royal College of Psychiatrists and AIMS rehab quality network. There was no policy on self-medication which meant patients could not develop these skills.
• One out of the two medication cards had gaps where medicines had not been signed for on two days for a total of nine medicines.
• Despite managers being informed of incidents, they had not ensured that the incidents had reported promptly using incident reports. An incident where a patient gained access to Brocklesby Lodge from the health-based place of safety occurred in July which was not reported until after our inspection in August. We raised two medicines incidents with managers during our inspection and there was a three-day delay in completing an incident form to report these.
• One bank staff had not completed any training despite working for the provider for 14 months.
• Bank staff did not have access to the electronic patient record system. They relied on other staff to be able to read or input information.
• There was no policy on ligature risk reduction and no fire policy at the time of our inspection. However, the provider had written a draft fire policy and added management of ligature risks to their observation policy after the on-site inspection but submitted within the inspection window timeframes.
• One patient record contained a T2 which was completed on behalf of the Responsible Clinician. When we raised this, the Responsible Clinician rewrote the T2. However, they did not complete a capacity assessment to assess the patient’s capacity to consent to treatment to check that the patient continued to consent.
• Two rooms used to support treatment and care were not soundproof and this meant that patients’ privacy may not be upheld.

However:

• The ward was very clean and well maintained.
• Staff assessed and managed patient risks well including monitoring physical health. The use of restrictive interventions was low.
• Staff felt respected, supported and valued. They recognised the provider’s vision and values and could raise concerns without fear of retribution.

Updated 15 February 2018

Our rating of this service improved. We rated it as outstanding because:

• Staff truly respected and valued the patients as individuals. They were empowered as partners in their care both practically and emotionally. Patients and carers were continually positive stating that staff care and support exceeded expectations. Staff recognised and respected the totality of the patients’ needs and provided a strong visible person-centred culture.
• Staff demonstrated clear evidence that the service was tailored to focus on the needs and preferences of the patients. They understood the individual preferences of each patient and used a flexible approach, found innovative ways to ensure choice and went the extra mile to ensure these needs were met.
• The facilities on the ward offered exceptional comfort and were designed to offer patients an environment more associated with a person’s home than a hospital ward. The bedrooms were all individual including en suite facilities. Some had small kitchenette areas and lounges encouraging independence. Some had additional sleeping facilities specifically for the use of family members if this was required.
• Staff consistently considered a patient’s privacy and dignity. They found innovative ways to enable patients to maintain their independence as much as possible. The ward ensured a patient’s family were involved in all aspects of the care provided where this was agreed.
• The ward had strong leadership, which steered a culture to deliver high quality person-centred care. There was a systematic and integrated approach to monitoring and reviewing progress in line with strategic plans.
• There were high levels of staff satisfaction among all staff and an inspired shared purpose. All staff embedded the organisation’s mission to deliver services they would be happy for their family to use. They felt fully involved in decisions about the ward and had no reservations about contributing to ideas or expressing any concerns.
• Staffing levels were good. There was a stable workforce with low sickness, turnover and vacancies. The service did not use agency staff; bank staff were all familiar with the ward. Patients received daily one to one support. All patients and carers we spoke with, informed us that staff were always available, responsive and caring.
• There was a high compliance for staff completing mandatory training units. They were encouraged to participate in other specialised training additional to their mandatory requirements to develop skills beneficial to the patients on the ward. Staff received regular supervision and yearly appraisals.
• Staff assessed patient risks regularly. They managed identified risks effectively and ensured they shared these appropriately. The ward did not apply blanket restrictions on patients.
• The service followed best practice guidance to plan patients’ individual care and treatment. Staff ensured patients were active partners in their care, producing personalised care plans which included physical health, mental health, social and emotional needs and goals.
• The ward was clean and well maintained. There was appropriate monitoring of environmental risks and health and safety requirements. The provider responded quickly when repairs or maintenance work was required. Staff, patients and visitors to the ward all felt safe.

However:

• Staff had not received training specifically around the Mental Health Act and the code of practice.
• The provider’s recording of restraint was inaccurate. The system did not differentiate between different levels of restraint and indicated the use of prone restraint, which had not occurred.

Updated 11 December 2019

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

• The ward environments were clean. The wards had enough nurses and doctors. The use of restrictive practices was low, they 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.
• 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.
• 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

However:

• There was no policy on ligature risk reduction and no fire policy at the time of our inspection. However, the provider had written a draft fire policy and added management of ligature risks to their observation policy after the on-site inspection but submitted within the inspection window timeframes.
• There were no personal emergency evacuation plans in place for those that needed them.
• One bank staff did not have access to the electronic patient record system and had not completed any mandatory training.

Updated 15 February 2018

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

• Clinic rooms were tidy and contained all the equipment required to carry out physical examinations. There were enough staff with the right qualifications and skills to care for patients who used the service. The service used a recognised risk assessment tool to assess and manage potential risks to patients and staff.
• Medication was stored in line with national guidance. Staff followed good practice in relation to medicines management. The provider reported serious incidents and carried out investigations where needed.
• The service provided care and treatment based on national guidance. There were a range of specialists to meet the needs of patients. Processes were in place for the support and management of staff performance. Staff had a good understanding of the Mental Health Act and the Mental Capacity Act.
• Staff treated patients with compassion. Patients were involved in decisions about their care and treatment. Patients were able to make advance decisions about their care and treatment. Patients and carers were encouraged to give feedback on services and the care they received.
• Services were meeting the national target for referral to triage/assessment and from assessment to treatment. Staff were flexible with appointment times. Both community health teams had suitable premises to provide care, support and treatment. Information was available to patients in different formats. Patients were given information on how to make a complaint. Learning from complaints was shared during team meetings.
• The provider had a robust recruitment process. The organisations values were included in annual performance reviews. Regular audits were carried out to ensure the safety and quality of services. Recommended changes were implemented following incidents. The provider had a risk register in place which was regularly reviewed.
• Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Computers and software were password protected to ensure confidentiality. The provider had a website which contained information about services provided, news and events.

However:

• Not all staff received regular supervision and appraisal. Some staff had not completed the provider’s mandatory training.
• The provider did not include Mental Health Act training in their mandatory training package.
• Patients who lacked capacity were not routinely referred to advocacy services