Eleanor

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all the quality statements in the safe key question and found it to be good. The provider had previously been inspected and safe was rated as requires improvement. Our rating for this key question is good. There were safety policies in place to make sure the environment was safe for patients to be assessed in. We toured the environment of the ward and found it to be well maintained. There were effective systems and processes to protect people from abuse and neglect. Staff understood how to protect patients from abuse and had received appropriate training. Staff completed risk assessments for patients. There was sufficient staff to support patients with a full multi-disciplinary team in support.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed community’ meetings and saw evidence that the patient was consulted on all issues within the ward. They felt they could raise concerns, and they were listened to.

All staff had received an induction, which included a period of shadowing other staff members. Staff, including domestic staff told us they received debriefs and staff felt they were able to raise concerns.

At the last inspection, there were gaps in the providers ability to maintain staff personnel records, staff did not reassess observation levels after incidents and staff had not completed observation records accurately. On this assessment we found the provider had put in place systems for managing the patient incidents. Managers investigated incidents and there was evidence they disseminated learning amongst staff via learning events, briefings, and newsletters. We reviewed several incident reports and found them comprehensive in detail. All staff records were complete.

We saw that care and support was planned and organised, staff had negotiated where the patient could take unescorted leave. For example, staff would drop off the patient who would then undertake a journey on public transport and be met by staff at the destination. The views of the patient were listened to and considered. They could outline to us the next stage in their care, and they were working towards discharge.

Staff told us that thorough handovers and debriefs took place to ensure information was shared about the patient. Handovers were recorded and we saw they covered all the activity planned for that day, incidents that had occurred and changes to care implemented due to those incidents. Staff could tell us about the patient and discussed why they were completing observations and the risks presented by the patient.

We saw that partners were consulted on care decisions and invited to regular meetings to discuss the care of the patient.

We looked at daily briefing sheets and observation records. The handover sheet was a booklet that contained information about each patient. There was also an observation sheet for staff to record observations about the patient which was handwritten but included information about the patient’s demeanour and what activity they were undertaking. We crossed referenced the last three incidents and saw they were recorded in the handover and observation records.

The patient reported feeling safe on the ward and they felt that they could raise any concerns with staff or managers. They were aware of how to raise a complaint and described that they would feel confident in doing so. They had experienced restraint but told us they felt staff had dealt with them professionally and appropriately.

Managers could describe how safeguarding was managed on the wards and how any potential issues were escalated. Managers and staff were aware of who to contact if they needed any guidance or advice in relation to safeguarding. Managers reported that relationships with local safeguarding partners were positive. Staff understood how to safeguard patients and knew who to go to, to raise a safeguarding concern. There was evidence of staff raising safeguarding concerns in their files, and staff shared safeguarding concerns in handover meetings. A visiting room was available to book for visits with children which was separate from the ward.

We did observe staff, and we saw staff interacting positively with the patient. All the staff members we spoke to were aware of safeguarding and could outline what role they were performing and the safeguarding risks present.

Staff knew how to recognise adults and children at risk of or suffering harm and worked with other agencies to protect them. Staff discussed any incidents in the previous 24-hours at daily safety huddles to ensure all safeguarding concerns were captured and reported. From January 2024 staff had made seven safeguarding referrals. These included concerns about relationships online with people outside the service. Safeguarding mandatory training included adults and children up to level three and compliance was 100%. There were up to date policies providing safeguarding guidance to staff.

The patient told us they were always involved in the development of their care plan and risk assessment, and they had worked with staff to ensure the care plan was individualised. For example, they attended the cinema every Sunday and had worked with staff to develop the plan for this. They confirmed they had always had regular one to one session to discuss these. They also told us that staff had explained how they would support them if they began to feel agitated, and they had discussed these plans with staff to deescalate any incidents.

Managers were confident that staff would only use restraint where necessary and that staff could de-escalate incidents before requiring the use of restraint. They investigated all incidents and looked to identify trends to reduce the number of incidents. They completed blanket restriction registers and considered any potential blanket restrictions on their wards. Staff told us that they always had time to read the patients risk assessment and that they identified risks by reading the handovers and observation notes.

Since 1 January 2024 the service had recorded 154 incidents. There had been 40 incidents from July 2024, 3 months before the assessment. These incidents included low level self-harm, and injuries sustained such as trips or grazed skin. We found that care plans and risks assessments contained detailed guidance to often complicated behaviours. Staff we spoke with were able to describe the risk the patient presented to themselves or others.

The patient was happy with the environment, the ward had been refurbished in 2023 and was still in good condition. They had personalised their bedroom and they had been allowed to personalise the environment in communal areas. For example, they had asked for a special chair in the lounge. They agreed this with the staff and together they held a car wash event to raise money.

Staff told us they completed and regularly updated environmental risk assessments of all ward areas and removed or reduced any risks they identified. Housekeeping staff could clearly outline their cleaning schedule and the tasks they needed to complete daily.

We saw that where staff unable to observe patients, parabolic mirrors were used to cover blind spots. There were closed circuit cameras installed in communal areas, while this was not viewed on the ward it allowed managers to review safeguarding or incidents if required to do so as part of any investigation.

During the assessment we reviewed both environmental and ligature risk assessments. These were well written. Staff knew about any potential ligature anchor points and mitigated the risks to keep the patients safe. Staff had completed fire risk assessments for the building, and there was fire evacuation plans specific to each ward. Electrical and gas checks were in place. Staff had easy access to alarms and patients had easy access to nurse call systems. All bedrooms were fitted with alarms. Staff always carried personal alarms on them.

The patient knew all the staff, and felt they were better now at understanding how to support her. She always had leave and all appointments were kept. There was always enough staff to support leave, and the patient had attended a scare fest night event where individual staff had been selected to support them.

Staff told us that staffing levels were good, they felt they always had time to provide one to one support or support the patient’s leave. Staff also told us that the staff team was supportive and that they received debriefs following incidents. Bank and agency staff were nearly always the same staff, and we checked staff records for those on the rota and all had completed an induction and observation competency checks. There was support staff, for example an occupational therapist and assistant occupational therapist. Psychology was supplied by an outside contractor for two sessions a week as well as a professional development session for staff.

We saw that staff did engage with the patient; we saw them encouraging them to join them in activities. All staff could describe the patient and the needs, likes and dislikes of that patient.

There were no vacancies for nurses or health care assistants but because some staff worked a reduced hours rota there was a need for bank staff to provide cover. For nurses this was 12 hours a week and for health care assistants 6 hours a week. The total establishment for one patient was 4 nurses and 11 healthcare assistants. The service used bank staff to cover for other absences such as training or leave. The yearly rolling staff turnover rate was high at 51.9%, the number of staff posts in total was 23, managers pointed to recent staff resignations as the cause of this.

The patient did not raise any significant concerns in relation to the cleanliness of the wards or about infection prevention and control.

Staff followed infection control policy, including handwashing. They told us that they washed their hands to prevent infection, and that personal protective equipment was available. Managers had put in place audits to ensure staff cleaned all areas when required. Bedding and other soft furnishings were replaced according to the providers policy.

During the inspection we saw continuous cleaning activity, and the ward was clean and tidy.

Staff made sure cleaning records were up-to-date, and the premises were clean. We reviewed cleaning rotas and spoke with housekeeping staff; they were able to show us up to date and comprehensive records.

The patient was supported to have access to healthcare professionals to maintain physical and mental health. They were able to speak to staff and the pharmacist about their medication. There was no evidence that people’s behaviour was controlled by excessive and inappropriate use of medicines.

Staff were trained to manage and administer medicines. However, due to recent staff changes none of the staff were trained to obtain blood samples for clozapine testing. Managers had arranged for these to be taken by other trained staff from a different location. They had made arrangements to train staff in the near future.

We found medicines and related paperwork were stored securely. Staff recorded temperatures of areas where medicines were stored. Controlled drugs were stored securely according to legislation and policy. Medicines records contained information staff needed to administer them safely such as allergies. Medicines prescribed to be given when required (PRN) had clear indications and maximum doses recorded. Staff recorded the times that these medicines were given to ensure that the safe gap between doses was maintained. Medicines were administered safely. The appropriate mental health paperwork was in place.

Medicines safety alerts were reviewed and actioned by staff. Medicines records were completed accurately. When medicines were omitted, staff recorded the reason why. Medicines used in an emergency were stored safely and checked daily by staff. Staff followed national policy practice to check patients had the correct medicines when they were admitted or moved between services. We saw that when rapid tranquilisation had been administered, records of monitoring of side effects after its use were completed as per policy, except on one occasion. There had been seven incidents involving rapid tranquilisation from 1 January 2024.