Archived: Postern House

On the day we inspected there was one patient at the assessment and treatment unit who was due to be discharged to another service on 27 May 2014. Staff told us the unit would be closing at the end of June 2014.

We spoke with four staff which included nurses, occupational therapists, support staff and senior staff.

We looked at two patient records which included their care plans and risk assessments.

Although the content of the assessments varied, for example some were more personalised than others, all the records we looked at had been fully completed.

Other records we looked at included a 'matron's walkabout tool', staff support and supervision, incident reports and patient feedback forms.

We found that record keeping had improved since the last inspection. However, further changes could be made to improve records, especially regarding the documents for the transfer of people to other services.

The monitoring of the quality of the service had improved. All incident records had been reviewed, and there were regular staff meetings and assessments of the service carried out.

As a result of our inspection we asked the Trust to take action in order to achieve compliance. The Trust responded with an action plan telling us what actions they were taking to address the concerns. They told us they would be compliant by 7 August 2013. On 28 January 2014 we carried out a further inspection of Postern House to assess whether compliance actions had been met.

We spoke with relatives of the two patients. One relative said 'Lovely service, very caring. Atmosphere is not like a hospital. The whole team are wonderful.' Another relative told us they were very pleased with what was happening and explained that the service looked after all aspects of their relative's care.

However,we found that there was no effective system in place to identify, assess and manage risks to the health, safety and welfare of patients and others who may be at risk. We were concerned about the quality of information recorded on incident forms, the lack of access to them and the back log of 75 forms which had not been processed through the system and could not be used to inform care. Staff told us they were not debriefed or offered support following an incident of physical assault.

Both patients had what staff described as an accessible version of their care plan. An accessible care plan is a care plan which is written in a specific way so as to be understandable to the patient who may have complex needs. We saw that the accessible care plans provided by the service were in plain English and included some pictures but were so similar to each other that neither reflected the communication needs of individual people.

People who used the service told us that staff provided the care and support that they needed. However, we found that the behaviour support plans did not always contain sufficient information about the actions staff should take when they were required to restrain people who used the service.

Two people told us that they felt safe at Postern House and said they would be happy to talk to staff if they felt worried about anything. We spoke to a relative of one person who used the service, who said they had 'no concerns' about their relative's treatment and said they were very happy with the service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The systems for obtaining feedback from people who use the service were not robust and did not ensure that people could raise concerns independently of staff working in the service. People did not have the opportunity to raise issues without the knowledge of the staff who were providing their care and support. We also found that the systems for reviewing information in incident reports were not effective and increased the risk that lessons from incident would not be learned.