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

Archived: Butterworth Centre

Overall: Good read more about inspection ratings

36 Circus Road, London, NW8 9SE (020) 7055 1666

Provided and run by:
Sanctuary Care Limited

Important: The provider of this service changed. See old profile

All Inspections

17 January 2023

During an inspection looking at part of the service

We had previously rated this service as good with requires improvement for the safe domain. This was a focused inspection where we looked at the safe and well led domains. We did not re-rate the service as a result of our inspection.

  • The ward environments were safe and clean.
  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm.
  • Staff assessed and managed risks to patients and themselves well. Levels of restrictive interventions were low. Staff followed good practise with respect to safeguarding
  • Staff had easy access to clinical information and it was easy for them to maintain high quality clinical records.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Since our last inspection, improvements had been made in how covert medicines were managed.
  • The service managed patient safety incidents well. Staff knew when to report incidents and reported them appropriately.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.
  • Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for clients and staff.
  • Staff felt respected, supported and valued. They could raise any concerns without fear. Staff reported that since our last inspection the culture within the team had improved.
  • We observed staff treating patients with compassion and kindness and respecting their privacy and dignity.

However,

  • Staff did not always follow the providers infection control policy to protect patients from the risk of COVID-19 infection.
  • Staff used safe holds, usually involving holding a patient’s hand or arm, whilst providing personal care, which constituted a form of restraint. These safe holds were not always appropriately detailed in patients care and treatment records, in line with the providers policy and procedure.
  • Signage on the wards was not always appropriate for people with dementia.

8 – 21 July 2020

During an inspection looking at part of the service

This was a focused inspection we undertook to investigate specific concerns raised in respect of three key questions; is the service safe, are staff caring and is the service well-led? We did not re-rate the service following this inspection. We found:

  • The service provided safe care. The wards were clean and fit for purpose.
  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm.
  • Staff respected patients’ privacy and dignity when delivering personal care.
  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible and approachable for patients and staff.

However:

  • Staff did not always follow the provider’s policies and procedures when managing medicines. This included the administration of covert medication and the reporting of medicines incidents.
  • On the day of our visit three staff were momentarily not wearing the correct personal protective equipment.
  • Relationships within the nursing team did not always support a positive work culture but this had not directly impacted patient care or treatment.

11 & 12 February

During a routine inspection

We rated wards for older people with mental health problems at Butterworth Centre as good because;

  • Staff kept patients safe from avoidable harm. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, 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. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to specialists required to meet the needs of patients on the wards. Managers ensured that these staff received supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing care.
  • 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 involved patients and families and carers in care decisions.
  • The service managed beds well as part of the local continuing care pathway.
  • The service was well led by an interim management team, and governance processes ensured that most ward procedures ran smoothly. A new registered manager was due to start after our inspection.

However;

  • Some staff who were delivering care and treatment had not completed or kept up-to-date with their basic training.
  • Some areas of the hospital environment had not been well maintained and kept in good working order.

19 - 21 June 2017

During a routine inspection

Following this inspection, we rated wards for older people with mental health problems at Butterworth Centre as requires improvement because:

  • The environment needed work to ensure it was dementia friendly and to minimise disorientation of patients who lived with organic mental health conditions including advanced dementia.

  • Whilst overall, the provider maintained safe staffing levels, qualified nurses were under pressure as a result of their workloads. One qualified nurse was employed on each ward at all times, but they were often away from the ward attending meetings elsewhere in the building.

  • The provider did not ensure all staff completed mandatory training. In most areas less than 75% of staff had completed mandatory training. Whilst uptake of mandatory moving and transferring training was improving, we saw some instances of patients being poorly support with moving and transferring during the inspection. The provider took immediate action to provide additional training and support to staff in this area.

  • The hospital did not meet the requirements of the Department of Health same sex accommodation guidance, meaning that the privacy and dignity of patients could have been compromised. Patient bedrooms were situated on mixed corridors and the service did not provide a female only lounge.

  • Whilst the provider had systems in place to protect patients from abuse, staff understanding of their responsibilities with regards to safeguarding was variable and take up of mandatory training in relation to safeguarding was low at 50%.

  • A small number of incidents that should have been reported, had not been reported. For one patient at risk of being restrained when supported with their personal care an incident report each time this occurred had not been completed in line with the providers policy and procedure. Whilst learning and improvement as a result of incidents was taking place, a system to routinely share this learning with all staff was not embedded.

  • Staff did not receive regular one to one supervision sessions. Supervision took place for some staff sporadically. On occasions where supervision sessions had taken place, clinical discussions were not held.

  • Some medical equipment, on the ground floor, used to monitor patients’ physical health had not been calibrated.

  • Although group activities took place, there was a lack of person-centred, one to one activities to develop individual interests and promote recovery and wellbeing.

However,

  • A carers’ group had recently been set up. Carers told us they were well informed and involved in their relative’s care, and had the opportunity to feed back about the service at the carers’ group.

  • The environment was clean, well maintained and there were different areas for activities to take place. All patients had access to lockable spaces to keep their possessions safe.

  • Patients and carers were involved in care planning. They had contributed to detailed ‘about me’ sections. Permanent staff showed that they knew and understood the patients they cared for.

  • Patients had good access to advocacy. Staff referred patients to the advocate. The advocate also introduced themselves to patients and could be approached directly.

  • Physical health care provisions were in place. Ongoing physical health monitoring was detailed and physical health checks took place annually for all patients. A physical health lead nurse worked at the service three days per week and a general practitioner also visited twice per week. Physical health needs were discussed in detail during ward rounds.

  • Regular ward rounds involving doctors and nurses and nursing handovers took place. Notes were included in patient care records and were up to date.