Rotherham, Doncaster and South Humber NHS Foundation Trust Great Oaks

Transcription

1 Review of compliance Rotherham, Doncaster and South Humber NHS Foundation Trust Great Oaks Region: Location address: Type of service: Yorkshire & Humberside Ashby High Street Scunthorpe Lincolnshire DN16 2JX Hospital services for people with mental health needs, learning disabilities and problems with substance misuse Date of Publication: July 2011 Overview of the service: Great Oaks Hospital provides twenty - four hour in- patient nursing care and continuous assessment of the mental health state of patients who use services. Page 1 of 19

2 Summary of our findings for the essential standards of quality and safety Our current overall judgement Great Oaks was not meeting one or more essential standards. Improvements are needed. The summary below describes why we carried out this review, what we found and any action required. Why we carried out this review We carried out this review because concerns were identified in relation to: Outcome 01 - Respecting and involving people who use services Outcome 04 - Care and welfare of people who use services Outcome 07 - Safeguarding people who use services from abuse Outcome 14 - Supporting staff How we carried out this review We reviewed all the information we hold about this provider and carried out a visit on 8 June What people told us During the course of the visit to Sycamore House at Great Oaks Hospital, a total of 5 patients who use the services were asked about their experiences. Patients we talked to were generally positive about their care and experience in hospital. Comments included: 'I'm happy here' and 'it's alright here'. They told us that they were treated with respect and were involved in decisions about their care, especially in relation to activity planning and meals. Positive comments were received in relation to staff such as 'staff treat you right, they talk to you about everything'. What we found about the standards we reviewed and how well Great Oaks was meeting them Outcome 01: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our review of this service has shown us that patients who used the service were respected and involved in their care. However not all detained patients had been informed of their Page 2 of 19

3 rights within the appropriate timescales as determined by section 132 of the Mental Health Act (MHA) Outcome 04: People should get safe and appropriate care that meets their needs and supports their rights Our review of this service has shown us that patients who used the service were formally assessed and care was planned and reviewed so that their individual needs were met ensuring their health and welfare was maintained. However some detained patients who were subject to extended leave under Section 17 of the Mental Health Act (MHA) 1983 for a significant period of time had not been considered for Supervised Community Treatment. Outcome 07: People should be protected from abuse and staff should respect their human rights Our review of this service has shown us that there were appropriate systems in place to safeguard patients who used the services and staff were skilled in detecting volatile situations and protecting others where necessary. Outcome 14: Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our review of this service has shown us that staff were supported in their role and received appropriate training. There were structured appraisal and supervision processes that support staff in personal development. Actions we have asked the service to take We have asked the provider to send us a report within 7 days of them receiving this report, setting out the action they will take to improve. We will check to make sure that the improvements have been made. Where we have concerns we have a range of enforcement powers we can use to protect the safety and welfare of people who use this service. Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeal processes. We will publish a further report on any action we have taken. Other information Please see previous reports for more information about previous reviews. Page 3 of 19

4 What we found for each essential standard of quality and safety we reviewed Page 4 of 19

5 The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential standard. Compliant means that people who use services are experiencing the outcomes relating to the essential standard. A minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard. A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary improvements are made. Where there are a number of concerns, we may look at them together to decide the level of action to take. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety Page 5 of 19

6 Outcome 01: Respecting and involving people who use services What the outcome says This is what people who use services should expect. People who use services: * Understand the care, treatment and support choices available to them. * Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support. * Have their privacy, dignity and independence respected. * Have their views and experiences taken into account in the way the service is provided and delivered. What we found Our judgement There are minor concerns with Outcome 01: Respecting and involving people who use services Our findings What people who use the service experienced and told us Patients' we talked to were generally positive about their care and experience in hospital and told us they were treated with respect. They acknowledged that they were involved in decisions about their care, especially in relation to activity planning. Comments included 'It's alright in here',' staff treat you right, they talk to you about everything', 'I do understand about medication' and 'I'm happy here' Other evidence We carried out this inspection visit with a Mental Health Act Commissioner who has responsibility for monitoring the legality of detention and the protection of individuals' human rights under the Mental Health Act (MHA) 1983). We looked at the records for patients using the service and found that an initial assessment of their care needs had been undertaken and was documented within their records. The assessment records supported that patients' individual needs in relation to their religion, culture, language and family were identified. There was no evidence that patients were formally consulted about the choice in gender with regard to the staff member providing their care. Although no issues were identified during the visit, given the close monitoring support that some patients have in place this issue should be considered and recorded. Page 6 of 19

7 We found evidence in the nursing and medical records that the care, treatment and support offered to patients using the service had been discussed and the patients understanding of this documented. During our inspection we observed that patients' dignity was preserved during the delivery of care and the majority of patients that we spoke with told us that they felt they were treated with respect. Discussions with staff confirmed that the female and male accommodation was separated to support same gender privacy and this was appropriately managed within the confines of the current works programme at the hospital. Of the evidence reviewed and patients spoken to that use the services, we found that patients were encouraged to be involved with their care and offered a variety of choice in relation to how their care was managed. Patients were able to have their views taken into account at multidisciplinary team meetings and there were regular one-to-one discussions with patients that use the services. Care plans and risk assessments had been signed by the individual to demonstrate agreement to the support they received. From discussions with staff we found that they had a good understanding of patient's needs and the care and support they were receiving. Staff also told us that many of the training courses they had attended covered respecting patients privacy, dignity and rights and gave good accounts of how this was put into practice. There were no seclusion facilities on the ward due to the current works and refurbishment programme, people requiring this facility and support were transferred to an alternative placement. Evidence from records and discussions with staff confirmed that patients' families were involved in the continued care and support. In discussions the nursing staff told us that the rights of patients who use services are explained, or attempts are made to explain rights, at regular intervals in accordance with section 132 of the Mental Health Act (MHA) 1983 for detained patients. This was found to be the case in some instances but the records showed that a number of patients had not had their rights explained within the timescales needed. The Mental Health Act Commissioner requested that all patients had their rights read within 24 hours and that this was appropriately recorded. Patients have access to an independent advocacy service, weekly 'surgeries'were held on the ward. Information about the advocacy service was posted on notice boards and in leaflets. The manager confirmed that patients were informed about this service on admission and we discussed with the manager that it would be good practice to document this in patient records. Monthly support group meetings involving patients who use acute services, community services and carers were held at the hospital. The manager told us that the meetings provided emotional and practical support for patients and an opportunity for patients to Page 7 of 19

8 exchange views. The meetings were chaired by patients who use services and carers on a rotational basis. Observed staff interactions with patients showed that staff were respectful, caring and attentive to patient's needs. People that use the services are regularly encouraged to become involved in activities and care is person centred. Our judgement Our review of this service has shown us that patients who used the service were respected and involved in their care. However not all detained patients had been informed of their rights within the appropriate timescales as determined by section 132 of the Mental Health Act (MHA) Page 8 of 19

9 Outcome 04: Care and welfare of people who use services What the outcome says This is what people who use services should expect. People who use services: * Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. What we found Our judgement The provider is compliant with Outcome 04: Care and welfare of people who use services Our findings What people who use the service experienced and told us Patients we talked to were generally positive about their care and experience in hospital, and were involved in decisions around their care and support. Comments included ' Ive read and signed the care plan, also risk assessment', 'I am consulted about my care plan and have signed it', 'I understand my medication' and 'I'm happy here'. Patients who use the service told us that they were able to choose how they spent their time, some of the comments included:'i like to listen to music and watch the telly','i have been on a walk today' and 'I've tried to read several books but I'm bored' and 'there's something you can do'. Other evidence As part of our inspection we looked at medical and nursing records, talked to patients and staff. We found that comprehensive assessments of patients mental health needs were carried out and the plans of care reviewed during the visit were generally person centred, detailed and each had a supporting risk assessment. The risk assessments covered areas such as mental health problems, self neglect, risk of setting fire, violence and aggression, vulnerability, risk to children, substance misuse and suicide/ self harm. The records showed that care had been evaluated and reviewed as necessary in response to the patients' changing needs. We also looked at records for two patients who were detained under section 17 of the Mental Health Act (MHA) 1983 for detained people which showed that this leave Page 9 of 19

10 arrangement had been extended for a significant period of time rather than the patients being transferred to Supervised Community Treatment. There was little evidence in the records to support the decision process around this and the management were requested to review this situation with the responsible clinician and advise the Mental Health Act Commissioner of the outcome. Assessment records and care plans also showed that patient's physical health care needs were planned effectively and met. Care records showed how patient's physical health was monitored, the involvement of relevant health care professionals and outcomes from any consultation or treatment. One patient file showed that an individual had received emergency dental treatment and care plans were in place to support needs such as diabetes and constipation. Nutritional risk assessments were carried out and there was evidence that where concerns had been identified, regular monitoring of the patients weight and diet and fluid intake were in place. Supplementary records such as daily records were found to be detailed, up to date and included evidence of multi-disciplinary team input. Our review of the medical and nursing records showed that although the specific records required were generally in place and up to date, the accessibility of the information was not easy and the quality of some of the photocopied records was poor. We were informed by the modern matron that this issue had been identified within the Trust and improvement work to address the filing and accessibility of information within the files was being carried out. The modern matron informed us that recent restructuring of medical services has provided the hospital (acute services) with a named psychiatrist and also one for the community services, and this arrangement was working well. Daily multidisciplinary team meetings (MDT) were held which involved nursing staff, therapy staff and the consultant psychiatrist. We attended part of the meeting held during the inspection and viewed minutes of previous meetings. Patient's needs and support were thoroughly reviewed and discussed which included informed input from the therapy team about activities. We saw evidence in some patient's records about discharge planning and involvement with community support teams such as 'early interventions' and 'options' available to the individual. The ethos within the ward was generally one of inclusion. Although we observed the routines were busy, the atmosphere on the ward was calm and staff were seen to spend time sitting and talking with patients. We saw that patients were also encouraged to engage in social activities, therapy and review meetings. Discussions with the Occupational Therapist and a review of records showed personalised activity plans were in place and patients had opportunities to participate in a range of structured diversional and therapeutic activities. During the visit we observed patients occupied in art work, talking with staff, reading and a walk was arranged. In discussions with staff they told us that sessions and meetings were held for patients about the promotion of a healthy lifestyle and this was followed up in one to one Page 10 of 19

11 conversations. Patients told us that they had received support about diet, exercise and healthy living and there were opportunities to go on walks and use the exercise equipment available. Our judgement Our review of this service has shown us that patients who used the service were formally assessed and care was planned and reviewed so that their individual needs were met ensuring their health and welfare was maintained. However some detained patients who were subject to extended leave under Section 17 of the Mental Health Act (MHA) 1983 for a significant period of time had not been considered for Supervised Community Treatment. Page 11 of 19

12 Outcome 07: Safeguarding people who use services from abuse What the outcome says This is what people who use services should expect. People who use services: * Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld. What we found Our judgement The provider is compliant with Outcome 07: Safeguarding people who use services from abuse Our findings What people who use the service experienced and told us We observed positive interaction between the staff and patients who used the service through out the visit. Patients who used the service told us that they were treated with respect and they felt safe. Other evidence The modern matron informed us that multi- agency safeguarding meetings were held monthly and attended by the hospital staff, safeguarding lead for the local authority, police and other relevant agencies. We talked with four staff members. They confirmed they had completed adult and children safeguarding training courses. They all understood what forms abuse could take and were able to identify the correct reporting systems to ensure that allegations were reported and appropriate alerts were made. Staff confirmed their knowledge of whistle blowing procedures. Staff had access to a range of policies and procedures such as safeguarding, restraint, money and property procedures. Records of training evidenced that all staff had completed courses in adult and child safeguarding and physical intervention and that refresher courses had been accessed and planned for this years training programme. The modern matron reported that all staff were trained in conflict management and personal safety. They were taught appropriate techniques for physical intervention and restraint. The emphasis was that physical contact, as a means of controlling a situation, was a last resort. Staff were trained to employ other de-escalation techniques first Page 12 of 19

13 wherever possible and any incidents that have required physical interventions were recorded and reviewed. We saw detailed records for one patients which staff had completed following the use of physical interventions, the records described all the events leading up to the incident, the exact time period taken, the staff involved and the specific support they had provided. There was evidence of review of risk assessments and re- assessment following the incident. During observations of staff interacting with patients who used the services there were good examples of the use of de-escalation techniques and other strategies to support patients and protect others. We observed that staff were respectful and polite towards patients using the service and patients were relaxed and confident in their company. Our judgement Our review of this service has shown us that there were appropriate systems in place to safeguard patients who used the services and staff were skilled in detecting volatile situations and protecting others where necessary. Page 13 of 19

14 Outcome 14: Supporting staff What the outcome says This is what people who use services should expect. People who use services: * Are safe and their health and welfare needs are met by competent staff. What we found Our judgement The provider is compliant with Outcome 14: Supporting staff Our findings What people who use the service experienced and told us Patients using the services did not make any comments about this outcome. Other evidence We spoke to a range of different grades of staff and they all confirmed that they had received mandatory training and annual up dates. Comments we received from staff indicated that they were satisfied with the training provided by the Trust and they told us that further training for personal and professional development was available. All staff we spoke to had undergone an appraisal of their performance within the last year and any training requirements including personal or professional development were identified and evaluated through this process. Computerised training records were seen. The ward manager provided records which showed that peer clinical supervision meetings were usually held on the ward on a 2 weekly basis but more regular sessions had been held due to the implementation of the new service model. She also confirmed that individual clinical supervision was offered by the senior nursing staff. Staff told us that they felt that staff worked well as a team providing a good standard of care to patients. They felt that they were adequately supported to do their job and develop their skills if desired. Our judgement Our review of this service has shown us that staff were supported in their role and received appropriate training. There were structured appraisal and supervision Page 14 of 19

15 processes that support staff in personal development. Page 15 of 19

16 Action we have asked the provider to take Compliance actions The table below shows the essential standards of quality and safety that are not being met. Action must be taken to achieve compliance. Regulated activity Regulation Outcome Assessment or medical treatment for persons detained under the Mental Health Act 1983 Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 01: Respecting and involving people who use services How the regulation is not being met: Our review of this service has shown us that patients who used the service were respected and involved in their care. However not all detained patients had been informed of their rights within the appropriate timescales as determined by section 132 of the Mental Health Act (MHA) Diagnostic and screening procedures Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 01: Respecting and involving people who use services How the regulation is not being met: Our review of this service has shown us that patients who used the service were respected and involved in their care. However not all detained patients had been informed of their rights within the appropriate timescales as determined by section 132 of the Mental Health Act (MHA) Treatment of disease, disorder or injury Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 01: Respecting and involving people who use services How the regulation is not being met: Page 16 of 19

17 Our review of this service has shown us that patients who used the service were respected and involved in their care. However not all detained patients had been informed of their rights within the appropriate timescales as determined by section 132 of the Mental Health Act (MHA) The provider must send CQC a report that says what action they are going to take to achieve compliance with these essential standards. This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us within 7 days of this report being received. Where a provider has already sent us a report about any of the above compliance actions, they do not need to include them in any new report sent to us after this review of compliance. CQC should be informed in writing when these compliance actions are complete. Page 17 of 19

18 What is a review of compliance? By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. When making our judgements about whether services are meeting essential standards, we decide whether we need to take further regulatory action. This might include discussions with the provider about how they could improve. We only use this approach where issues can be resolved quickly, easily and where there is no immediate risk of serious harm to people. Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actions or compliance actions, or take enforcement action: Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying with essential standards, but we are concerned that they will not be able to maintain this, we ask them to send us a report describing the improvements they will make to enable them to do so. Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people. Page 18 of 19

19 Information for the reader Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public / Copyright (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Quality Commission Website Telephone address Postal address enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Page 19 of 19