The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Constance House Hospital

Overall: Requires improvement read more about inspection ratings

8 Colmore Road, Enfield, London, EN3 7AL (020) 8836 9650

Provided and run by:
Liaise (London) Limited

All Inspections

9 and 21 August 2017

During an inspection looking at part of the service

CQC previously inspected Constance House in August 2015. At the last inspection, the service received an overall rating of good.

At this inspection we rated safe as requires improvement and well-led as requires improvement. Therefore, we have rerated the service as requires improvement overall.

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

  • The provider had made a decision not to address any environmental concerns until it had made a decision about the future of the service.
  • The premises were not safe for patients. Ceramic tiles had been removed from the wall. This left the sharp, hard edges of the other tiles exposed.
  • The premises were not clean. Carpets throughout the hospital were severely stained. In one patient’s flat, there were stains on the walls.
  • The provider had not reported a safeguarding concern to the local authority safeguarding team. The service had not sent any notifications of abuse or allegations of abuse to the CQC since September 2016 even though an incident of abuse had occurred.
  • The provider did not investigate serious incidents and complaints in detail, which meant that patients may have been significantly affected in some way and that opportunities where missed to learn from incidents and complaints and reduce the likelihood of reoccurrence.
  • The provider did not have effective governance systems in place to assess, monitor and improve the quality and safety of the service. The provider had not addressed recurring issues identified in audits of cleaning and environmental safety. The provider did not have a local risk register that reflected concerns raised by the staff.

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

  • Staff produced comprehensive positive behaviour support plans for each patient. These plans clearly identified the triggers for patients’ challenging behaviour and details of how staff should respond.
  • Staff knew patients very well. They understood patients’ routines, rituals and indicators of increased risk and could respond by reassuring patients before situations escalated
  • Staff were trained in de-escalation techniques and used verbal de-escalation before physical interventions. Physical interventions involved a minimal use of force. Staff did not use seclusion or rapid tranquilisation.
  • There were sufficient staff on duty at all times. Staff spoke positively about their experience of working at the service and found the hospital manager to be supportive and approachable.
  • The provider had systems to ensure staff were up to date with mandatory training. Staff received regular supervision and annual appraisals.

4th - 6th August 2015

During a routine inspection

The service had robust systems in place for managing risk, incidents and safeguarding. Positive risk taking was embraced. Staff used positive behaviour support with patients which meant they used physical interventions as a last resort. Medication policy and procedures were safe and complied with National Institute of Clinical Excellence guidance. The service was appropriately staffed and both patients and staff felt safe.

Care and treatment was multidisciplinary team led, person centred, and involved patients. Records were accurate and up to date. Staff received appropriate training, supervision and appraisals. Staff demonstrated a good knowledge of the Mental Health Act and the Mental Capacity Act.

Care was being delivered in a kind, thoughtful and sensitive manner which respected patients’ dignity. Staff had a good understanding of the individual needs of patients and were skilled at de-escalating situations using effective listening skills and by responding sensitively to patients when they were distressed.Patients were fully involved in writing their care and discharge plans.

Staff worked with patients and external agencies to plan discharge from the point of admission. The service provided patients with access to a range of activities including occupational therapy support. Staff and patients were aware of the complaints procedures and the service worked to ensure that people’s individual needs were met.

Staff demonstrated a good understanding of the organisation’s values of person centred care and encouraging independence. We saw the adoption of these values reflected in the attitudes and actions of the staff. Staff felt safe, supported and happy in their roles. Senior management were visible and approachable. There was a wide range of clinical audits in place to monitor quality and safety. Outcome measures were used in ensure effectiveness of treatment. There was a focus on training staff in order for them to be able to provide training to colleagues. The service followed NICE guidance relating to medication and the Winterbourne view recommendations regarding interventions for adults with learning disabilities.

3, 9 January 2014

During a routine inspection

Patient's views and experiences were taking into account and this informed how their care and treatment was delivered. Patients spoken to told us that they were involved and consulted about decisions affecting their care and treatment. One patient said, "staff listen to what you have to say."

Care plans gave guidance for staff about how they should meet patient's needs. Daily notes showed that patients were taking part in activities and were being supported to access their local community. One patient told us, 'today I'm going for a walk in the park. I decided.' Changes to their needs were discussed with them.

This inspection was carried out because we took compliance action following an inspection in June 2013. We found that medicines may not always be handled safely. During this inspection we found that appropriate arrangements were generally in place in relation to the recording of all medicines.

We saw that staff understood patient's needs and how to support them. One patient told us, 'staff are good at doing what needs doing', and 'they do work well. They do their job fantastic.' Patient's their representatives and staff were asked for their views about their care and treatment and they were acted on. Patients told us and we observed that they felt that staff listened to them. Regular audits had been carried out covering a range of areas such as infection control, medications management and care planning.

7 June 2013

During an inspection looking at part of the service

We used a number of different methods to help us understand the experiences of people using this service. We talked to staff and looked at storage and record keeping of medication. One person came to the clinical room to have their medicines whilst we were inspecting and we saw that it was given professionally and with patience and explanation. Another person was going home for the weekend and we saw that their medicines had been prepared by the community pharmacist and they were supplied to the persons support worker so that their care could be continued.

During our inspection we found areas of poor recording of medication, lack of stock of some medicines, out of date policies and procedures and some lack of clarity around individual protocols for giving medicines as required.

14 March 2013

During a routine inspection

Before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We observed that patients were involved and consulted about decisions affecting their care. Staff knew how to communicate with patients. We saw that staff understood patient's needs. One person said, "the staff help me when I need it." Patients received the care and support they needed. Appropriate arrangements were in place in relation to the recording of medicine. We looked at seven medication records. Patients current medicines were recorded so that staff knew what medicines had been prescribed.

Patients told us that there were always enough staff to meet their needs. Where patients needed assistance they received support from an individual member of staff. We saw that staff understood patient's needs and how to support them. Staff were able to explain how they met the needs of patients. Patient's records including their care plans were accurate. Records were kept securely and could be located promptly when needed. We saw that staff handled records with regard to protecting patient confidentiality and privacy.

26 January 2012

During a themed inspection looking at Learning Disability Services

Patients, staff, relatives and a visiting health professional provided us with their views of the service. We spoke with five patients, six members of staff, two relatives and one external healthcare professional.

Patients told us about the things they liked about Constance House:

'It's OK here. I like everybody. If you want to talk to staff you can. That's why they are good.'

'I am moving soon' getting my own place. It's happening slowly.'

'I make my own hot drinks and do some cooking and my laundry. We have curry and the sort of food I would have at home.'

'I get enough choice here. My advocate comes every week and I can talk to them on the phone as well.'

'Staff help me to keep healthy. I have a massage once a week and I go to the gym. Staff help me with my medication and remind me to eat my lettuce.'

'I go to the manager when I'm not happy.'

'The manager is a very nice woman.'

'I give the staff 10 out of 10. They are always there for me. I like baking and they make cakes with me. I have a key worker and she tells me to calm down when I get angry.'

Patients also told us of the things they did not like about Constance House:

'I don't like it here, it's too noisy. I can hear the television at night and I can't sleep.'

'I don't like the food here. I had a burger yesterday and it was too fatty and they make too much rice.'

We spoke with relatives of two of the patients. Their comments included:

'I am 100% satisfied with my daughter's care and I can go to bed and go to sleep knowing that she is safe and well cared for. We would like her to stay there. It's the best place ever. We were impressed that when two of the staff supported her to attend a family wedding the staff got dressed up for the wedding as well. My daughter had pulled her hair out at a previous placement because she was so unhappy but it has grown back since she moved to Constance House. On her first night there she was impressed that she did not have to go to bed at a set time. The staff have involved me in meetings and in making decisions about my daughter's care and they have always treated us both with the utmost respect. I would know if the staff were treating my daughter badly because it would show in her behaviour.'

'The care at Constance House is very good. I have no concerns about my daughters care and she always wants to go back there when she comes home to visit.'

Staff told us that Curo Care Limited had provided them with regular training about how to care for people and keep them safe. We heard that company directors and clinicians had provided training, advice and support. In addition, we were told that senior staff visited the hospital regularly and were available in an emergency.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.