Archived: The Huntercombe Hospital East Yorkshire

Care planning systems had improved and patient's files had been updated. There was evidence that patient's had been involved in their care planning. Systems were now in place to support patient's with weight management and they told us they were happy with activities.

One patient said to us 'Staff have done a lot for me' with another patient stating 'This is the best hospital I have been in.'

Staff were clear on their roles in relation to safeguarding with policies now in place and training being completed. Restraint was not used regularly in the hospital and staff had received training in de-escalation techniques.

Improvements had been made to the medication systems used in the hospital. However further improvements were required in order to ensure patient safety with regard to medication.

We found that the hospital environment was clean; work had been undertaken and remained in progress to help ensure patient safety.

Clinical audit systems had been improved and the new systems included a variety of topics which were reported to managers and reviewed at multi-disciplinary meetings.

We found concerns with information sharing and the handling of complaints, and relatives told us they did not feel involved.

Records were not handled securely and four incidents had recently occurred were data protection was compromised.

When we spoke with patients they told us that the hospital was a 'Settled environment', they liked the way staff talked to them and they were now doing more activities. However, one person said that living in the hospital 'Felt like a prison'.

We received varying comments from relatives of patients. Two relatives were satisfied with communication arrangements that were in place but another felt they were not kept informed. One relative said that their relatives care was 'Brilliant', but another had concerns about the patients personal hygiene needs not being met, and ligature risks for their relative. Two relatives raised concerns about patient's weight and health. We found that, despite patients being overweight, there was no hospital approach to obesity. This did not promote patient's general health needs and had the potential to create a risk of harm for some patients.

We found that care plans did not always include details of the latest needs of the patient; this included completion of antecedent, behaviour and consequence (ABC) charts and seclusion records. One management plan described seclusion rather than segregation which was how the patient was being nursed. Health check documents did not include comprehensive information and were not always accurate. For one patient monitoring of a health condition had not been supported by an up to date care plan. This lack of accurate and up to date information could have placed patients at risk of not receiving appropriate care and support.

The majority of records in relation to medication were accurate, with medication being ordered and stored appropriately and the Mental Health Act status of patients being recorded. We observed medication being administered appropriately. However we found three incidents when medication had not been administered as prescribed, with one example of tests results not being recorded appropriately. There had been an investigation into a medication error but we were unclear about the findings or lessons learnt in respect of this.

Staff were aware of the signs of abuse but no formal training had been given to staff on how the new safeguarding process worked and staff were not clear about the role of the local safeguarding adult's team. This could have led to some incidents not being reported to the appropriate professionals. We found that a high number of reported incidents did not have investigation findings and consequently gave no learning opportunity for staff to minimise future risk. Additionally staff training on basic life support was only at a 57% completion rate. This meant that there was a risk that people would not receive emergency treatment promptly.

We saw that some changes had been made to the environment to make it more homely and that patients had been involved with this process. However, we visited the seclusion rooms and looked at both cleanliness and safety. We had concerns that the hospital audits had not identified any issues but that we found a mattress and blanket which were damaged and which did not meet a person's dignity or health and safety needs. Sharp edges remained in these rooms and we identified new ligature risks.

We found that the provider had undertaken a lot of work in relation to clinical governance and audits. Audits including ligature audits had been implemented although we found that some of the audits were not robust as they had not identified the risks that we identified during the inspection. Managers told us how learning from incidents had taken place. However, when we spoke to staff they were unclear about learning opportunities.

The provider had commenced but not completed work against the Winterbourne recommendations. We were concerned that the recommendations from Winterbourne had been available for some time and the hospital had yet to fully respond to these.

At this inspection we found that there were examples of repeated non-compliance in a number of areas, including that a patient's detention had lapsed, concerns about patient's weight and the identification of ligature risks. There was a lack of evidence of sustained compliance and a lack of monitoring by the provider through their audit systems to ensure that standards had been met.

Patients told us that they were happy with the care provided. Interactions between patients and staff were positive and respectful.

Not all relatives felt that communication was good, arrangements for visiting varied and one person felt their relative had 'Regressed' since moving there.

People's needs were assessed but this information was not always transferred into authorised care plans that were reviewed. Patient's legal paperwork was not always correct.

However patients were undertaking activities and receiving section 17 leave.

Staff were aware of reporting issues of safeguarding but the policies and procedures in place did not fully meet the required guidance.

We found concerns with medication in a number of areas for example, the use of an unlicensed medication and incorrect practices regarding administration of medicines.

Although some areas had been refurbished we did not see any assessments of environmental risk to patients and it was unclear if these areas met with the latest guidance. We had concerns with the safety and cleanliness of the seclusion room.

We found that concerns regarding the incorrect recruitment practices had been met.

Staff were supported to undertake training to assist in supporting people, although more specialised training could be undertaken.

We had a number of concerns in relation to the governance and clinical audits completed in the hospital. These were either not in place or not substantial enough to ensure that people were kept safe and free from the risk of harm. This included clinical risk assessments to ensure peoples safety. External audits and national benchmarking for current best practice was not taking place.

There was manager in post who staff felt was approachable and who could demonstrate her leadership qualities.

We found that the hospital had not followed the correct recruitment practices and one doctor had been employed who did not have approved clinician status in England.

We found that this doctor had authorised the detention of a patient which meant that they had been detained illegally.

We saw that there were now more nurses employed within the hospital and less agency hours were used. Additional hours were completed by staff known to the patients.

The hours provided across the wards reflected the level of support required on that ward and staff felt they could now take more breaks and attend meetings. Patients told us that activities had improved but on occasions section 17 leave was either confirmed very late or still cancelled due to staffing.

Training of staff was taking place but some gaps remained that required addressing.

Staff told us that they felt well supported and supervisions had started to take place for staff to support them in their role.

The policies and procedures had been reviewed so that they reflected the actual provider organisation and not the predecessor. Management review meetings took place regularly and patients told us they were involved in meetings about the hospital.

We found that work had been undertaken to change policy and practice within the hospital to help ensure that patients were supported through least restrictive practices.

Patients and staff told us there were less restrictions on patients and that blanket policies for searches no longer existed. Patients told us that life in the hospital was better.

Patients told us 'Staff are supportive' and 'Staff are good and helpful but there are a lot of rules. They all work hard to help me and the others, I trust them'.

Patients told us about restrictions, 'The doors are locked to the kitchen and I have to ask staff. I am only allowed two snacks a day after 3 pm'. Some patients told us that searches were completed when leaving and returning to the hospital, if they refused to give their permission this would be cancelled. Patients also said leave was often cancelled due to a lack of staffing.

We observed that staff displayed a genuine concern for patients. However, there was a lack of staff and not all staff had the correct level of training or support.

We found concerns with care planning, rules for patients, seclusion, restraint and section 17 leave. Also that the environment was not suitable in the seclusion rooms and issued an urgent compliance action to the hospital due to the risk of injury.

The quality assurance systems were not robust to ensure risks were identified and practices safely met people's needs.