3 and 4 August 2016
During an inspection looking at part of the service
The previous comprehensive inspection of Bloomfield Court and 5, 6 Ivy Mews took place on 29 September and 1, 7, 8 and 15 October 2015. CQC rated the service as inadequate overall. We told the provider, Sequence Care Limited, to make immediate improvements and the provider agreed not to admit any new patients.
We published the report of that inspection in April 2016 and placed the service in special measures. The aim of placing a service in special measures is to ensure significant and timely improvements are made to the quality of the service in order to reduce risks to patients. The provider developed an action plan to improve the service. The CQC has worked in partnership with stakeholders to oversee the implementation of the action plan.
CQC carried out this unannounced focused inspection to check if the provider has made sufficient improvements to the service and whether further action was required in line with our enforcement powers. As this was a focused inspection we did not rate the service.
At this inspection, we found the provider had made some improvements to the service in response to our previous findings. However, overall these changes were not sufficient for CQC to take the service out of special measures. We were concerned that the provider’s governance arrangements were not sufficiently robust to independently identify risks and act swiftly to make improvements.
Since the last inspection, commissioners had arranged for several patients to be discharged from the service. At this inspection the number of patients using the service had reduced to seven from the 15 who were using it at our last inspection. The provider had not significantly reduced staffing levels. Consequently, there was now a higher ratio of staff to patients. Staff had the opportunity to get to know patients better.
Since the last inspection, the provider had made some changes to the premises and improved the appearance of communal areas. However, at this inspection we found that patients’ bedrooms and bathrooms were not well maintained or kept clean.
Since the last inspection the provider had undertaken an active programme of recruitment. However, some recently recruited staff, such as a registered manager and a clinical psychologist had since left the service. There was evidence of more consultant psychiatrist input to the service in the two months before this inspection and the frequency of multidisciplinary meetings had increased.
At this inspection we found some evidence that overall staff were responding more appropriately to incidents of challenging behaviour. However, there were inconsistencies in relation to record keeping about incidents of challenging behaviour. This meant we were unsure about the actual frequency of incidents.
There had been improvements in the completion of training at the service with rates of staff completing courses in managing restraint at 85%, understanding the Mental Capacity Act at and DoLS at 91% and adult safeguarding at 92%. There were sound arrangements to track the progress of safeguarding referrals and the take up of training. Handover arrangements between shifts had improved and records of these showed key issues were noted and acted on. The meals on offer to patients had improved and included healthy options.
Record-keeping processes were complex. There were inconsistencies in the way information was recorded which meant it was unclear what the actual facts were in relation to patients’ physical health. Although a GP was now undertaking physical health checks we could not be certain from the information available that these checks were appropriately tailored to each patient and sufficiently comprehensive. Care plans did not always include goals for patients which could be easily measured so it was difficult to monitor patients’ progress in the service. The provider had ensured that patients now had discharge plans.
We have taken action in relation to the breaches of regulations found at this inspection.