- NHS mental health service
Caludon Centre
All Inspections
21-24 January and 2 July 2014
During an inspection looking at part of the service
The Caludon Centre in Coventry is a purpose built facility providing inpatient mental health and learning disability services for adults of working age and mental health services for older people.
Sherbourne
Core service provided: Psychiatric Intensive Care Unit
Male/female/mixed: mixed
Capacity: 11
Spencer
Core service provided: Acute Admission
Male/female/mixed: female
Capacity: 14
Beechwood
Core service provided: Acute Admission
Male/female/mixed: mixed
Capacity: 20
Hearsall
Core service provided: Acute Admission
Male/female/mixed: mixed
Capacity: 20
Swanswell
Core service provided: Older People
Male/female/mixed: mixed
Capacity: 22
Quinton
Core service provided: Older People
Male/female/mixed: mixed
Capacity: 16
Gosford
Core service provided: Services for people with learning disabilities and autism
Male/female/mixed: mixed
Capacity: 9
We found a number of inconsistencies across the different services and good practice within wards had not been shared with other wards.
Some wards were regularly short of substantive staff and there was a heavy reliance on bank or agency workers. Some staff did not know the ward routines and as a result, people did not always receive the care they required. There was little continuity of care for individuals. Some staff did not know about the person they were caring for and had not had an opportunity to read the person’s care plan records.
On some wards, staff were not trained specifically to meet people’s needs and this increased risks to both staff and people using the service. Some staff told us that they had direct contact with their managers while others had little face-to-face contact and had not received supervision or attended team meetings.
There was a system for staff to report incidents that were then reviewed and acted on by managers. However, we found that regular incidents had taken place on Quinton ward, but there was nothing to show that learning from these incidents had taken place to prevent them happening again.
We found the Caludon Centre did not always adhere to the Mental Health Act’s Codes of Practice. Some records did not show that people had been told about their rights under the Mental Health Act which could have impacted on their understanding of how to appeal against their detention and how to obtain the services of an independent Mental Health Advocate to support them.
Some wards were better managed than others and on those wards, there was a lack of support for ward staff.
A risk assessment process was in place; however much of the documentation seen in people’s personal files was incomplete to demonstrate personal risk and been considered. We were told that the doors in place were specially commissioned doors to be ‘anti- ligature’ but the closure was visible when the door was open.
On some wards, people had detailed care plans that showed staff how they should be supported and we saw they were involved in these. Other records were unclear and had not been updated regularly. This meant that staff might not know how to support people to reduce risk and meet their needs.
On some wards, staff worked with the team of professionals involved in each person’s care to ensure that all their needs were met. Staff worked with other providers so that when the person was discharged they received the support they needed.
In outpatients, doctors talked with people and gave them, and others involved in their care, opportunities to raise and discuss issues. The doctors responded to these issues, such as side effects relating to medication.
There was the potential of a risk of harm for the people on Quinton Ward which had a number of breaches in regulations. We had sufficient serious concerns regarding Quinton Ward to issue a Warning Notice regarding this ward. The trust sent us an action plan following the inspection to detail how they were planning to implement improvements. We undertook a follow up inspection in July 2014 and found the trust had taken action to improve the outcomes for people on this ward. We found that the trust had responded and that the ward was much improved with sufficient improvement to remove the warning notice. Details of this visit and our findings can be found within the Older People section of this report.
21 January 2014
During an inspection
21-24 January 2014
During a routine inspection
The Caludon Centre in Coventry is a purpose built facility providing inpatient mental health and learning disability services for adults of working age and mental health services for older people.
Sherbourne
Core service provided: Psychiatric Intensive Care Unit
Male/female/mixed: mixed
Capacity: 11
Spencer
Core service provided: Acute Admission
Male/female/mixed: female
Capacity: 14
Beechwood
Core service provided: Acute Admission
Male/female/mixed: mixed
Capacity: 20
Hearsall
Core service provided: Acute Admission
Male/female/mixed: mixed
Capacity: 20
Swanswell
Core service provided: Older People
Male/female/mixed: mixed
Capacity: 22
Quinton
Core service provided: Older People
Male/female/mixed: mixed
Capacity: 16
Gosford
Core service provided: Services for people with learning disabilities and autism
Male/female/mixed: mixed
Capacity: 9
We found a number of inconsistencies across the different services and good practice within wards had not been shared with other wards.
Some wards were regularly short of substantive staff and there was a heavy reliance on bank or agency workers. Some staff did not know the ward routines and as a result, people did not always receive the care they required. There was little continuity of care for individuals. Some staff did not know about the person they were caring for and had not had an opportunity to read the person’s care plan records.
On some wards, staff were not trained specifically to meet people’s needs and this increased risks to both staff and people using the service. Some staff told us that they had direct contact with their managers while others had little face-to-face contact and had not received supervision or attended team meetings.
There was a system for staff to report incidents that were then reviewed and acted on by managers. However, we found that regular incidents had taken place on Quinton ward, but there was nothing to show that learning from these incidents had taken place to prevent them happening again.
We found the Caludon Centre did not always adhere to the Mental Health Act’s Codes of Practice. Some records did not show that people had been told about their rights under the Mental Health Act which could have impacted on their understanding of how to appeal against their detention and how to obtain the services of an independent Mental Health Advocate to support them.
Some wards were better managed than others and on those wards, there was a lack of support for ward staff.
A risk assessment process was in place; however much of the documentation seen in people’s personal files was incomplete to demonstrate personal risk and been considered. We were told that the doors in place were specially commissioned doors to be ‘anti- ligature’ but the closure was visible when the door was open.
On some wards, people had detailed care plans that showed staff how they should be supported and we saw they were involved in these. Other records were unclear and had not been updated regularly. This meant that staff might not know how to support people to reduce risk and meet their needs.
On some wards, staff worked with the team of professionals involved in each person’s care to ensure that all their needs were met. Staff worked with other providers so that when the person was discharged they received the support they needed.
In outpatients, doctors talked with people and gave them, and others involved in their care, opportunities to raise and discuss issues. The doctors responded to these issues, such as side effects relating to medication.
There was the potential of a risk of harm for the people on Quinton Ward which had a number of breaches in regulations.
12, 13 September 2012
During a routine inspection
We spoke with five patients and two relatives of patients at the Caludon Centre. We also spoke with five staff members and the managers for the wards we visited.
Patients we spoke with told us that they could talk to staff about their care and felt their views were listened to. We saw that patients had an opportunity to speak to the consultant on ward rounds to discuss their care. Patients we spoke with told us that they knew who their named nurse was and they could talk to them when they wanted to.
Relatives we spoke with told us that they felt involved and informed about their family member's care. We saw within care plan records that relatives were involved with the planning and review of their family member's care. We saw that easy to understand medication information sheets were given to patients and relatives, which explained what side affects could be experienced by the patient.
Staff members we spoke with felt they were supported within their roles.
We saw there was a system which monitored any incidents on the wards or when restraint was used on patients. These were reviewed on a monthly basis.
17, 18 October 2011
During a themed inspection looking at Learning Disability Services
We asked the patients about the activities that they enjoyed. All the patients that we spoke with said they were bored, and that there was very little to do.
One patient said, 'I would love to make a big mess with paints in the art room, spread it out on the floor and on the walls, then I could spend my time cleaning it all up. I like cleaning and it would keep me busy doing something'
Others said, 'We need activities, something to do, there is art stuff but I would like to make something like badges, fridge magnets, moulds with plaster.' Another patient said, 'Some adult board games would be good, there should be a selection of things to do for all types of people not just baby things'
Another patient said, 'It's the same all day every day. There's the art club on a Wednesday then it's watching TV and just sitting'
We asked patients if they felt safe and well cared for despite the lack of activities that were being provided. They told us that staff were kind, caring and supportive and that they did feel safe.
Patients told us that although they felt well cared for they did not feel that their discharge was well planned. This is as they do nothing on the ward to enhance daily living skills such as making drinks, preparing food, shopping or washing. One patient told us 'Everything is done for you here. I won't know how to do anything when I get back to my flat'.
24 April 2011 and 24 March 2012
During a routine inspection
We spoke with a number of people about the care, support and treatment they receive. People were able to confirm that their views were listened to and that they were fully involved in their case reviews.
People we spoke to told us that they felt that they were looked after well. One person said they were beginning to feel 'much better than when I got here', whilst other comments made were 'I understand why I have to do the things I do, it all works towards getting me well' and 'I am making progress here'.
People we spoke to in the adult wards made varying comments about the food that they are provided with. On one ward we were told 'It's ok, it stops me from being hungry', whilst on another we were told 'there's a good choice, I really like being able to have a salad if I want'. Where people had comments on the food in the elderly wards, they said it was 'good'. Another person said the food was 'very good'.
Reactions from people that we spoke to showed us that they felt safe from abuse. One person told us they could sometimes get a little 'frightened' when one or two male patients 'got a bit silly', but that staff always kept them safe and calmed down the person concerned. One person we spoke to told us 'the garden is good', whilst another said that she appreciated 'the quiet space outside, it's very tranquil, and allows me to think'.
People we were able to speak with on the older people's wards were positive about staff, commenting that 'they are nice people' and 'the staff are good'. This positive theme was also reflected in other wards that we visited, with comments such as 'The staff are nice, but I wish they'd spend more time talking to us rather than writing about us', 'they treat me well' and 'they're a good bunch I guess' being made.
People told us that they felt that their views and opinions were listened to, with one person commenting 'If we suggest something they seem to listen to us'. Other comments made included 'I like it that they involve me in what's going to happen to me', and 'I have a named nurse that I can talk to, but I can talk to anyone actually'.
A recent letter in a local newspaper positively reflected on the service, including comments such as 'I have had many years of experience with the (Caludon) centre and have received nothing but kindness, help and support', along with 'I have suffered like many from bipolar disorder and would like to thank the staff for their kindness and sensitivity to this condition'.