14-15 September 2016
During an inspection looking at part of the service
We found the following issues that the trust needs to improve:
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We were concerned about the safety of some of the ward environments. Many of these were issues that we had raised at our last inspection. Staff did not always assess risks on wards or manage risk from ligature points well; including on wards with poor lines of sight. The Christopher unit and older people wards that admitted both men and women did not comply with the requirement to provide same-sex accommodation. The Christopher unit’s seclusion room did not meet the standards outlined in the Mental Health Act Code of Practice. Staff subjected patients to blanket restrictions on acute wards. The trust was not sharing learning from incidents effectively with staff and the trust’s incident reporting policy and procedures needed updating to reflect national guidance.
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The trust did not ensure wards were fully staffed as wards staffing shifts were unfilled due to staff sickness or leave; all wards had staffing vacancies, and were using bank and agency staff. The trust did not ensure that staff received clinical supervision and training regularly.
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The trust did not ensure a consistent approach to staff administration and storage of medication across acute and older people wards as we found gaps in staff records and problems with medication storage.
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Staff did not check the equipment and environment in line with trust policy. Refurbishment work and repairs were not always finished to a high standard.
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Fifteen percent of patients’ records did not contain detailed information which included risks and they had not been updated regularly.
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Staff had recorded 26% of staff restraints on patients on these wards were in a prone position.
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The trust staff survey action plan did not detail how the trust was responding to the key issues from the 2015 results.
However we found the following areas of good practice:
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Ninety five percent of patients gave positive feedback about the staff, and their experience of care on the wards. Eighty seven percent of patients and 66% of carers said they were involved in discussions about their or their relatives care. Seven wards used ‘my care, my recovery’ booklets to capture this involvement. Staff and patients spoke positively about the restraint training staff used and said the new techniques made them feel safe and less fearful.
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Ward staff used regular agency and bank staff to ensure that patients received consistent staff care.
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Ninety one percent of patients had comprehensive and detailed risk assessments.
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Managers at Chelmer and Stort Mental health wards gave examples of effective performance management of staff. The trust had an independent ‘Guardian Service’ for staff to contact regarding any matters relating to patients’ care and safety, and staff concerns.
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Staff on older people’s wards were proud of their work and felt supported to deliver care. They were changing to use a ‘functional model’ with reference to the ‘new ways of working’ initiative led by the Royal College of Psychiatrists and the National Institute of Mental Health in England.