• Mental Health
  • Independent mental health service

Archived: Abbey Court Independent Hospital

Overall: Good read more about inspection ratings

Ainscough Road, Birchwood, Warrington, Cheshire, WA3 7PN (01925) 854150

Provided and run by:
Alternative Futures Group Limited

All Inspections

12 December 2016

During an inspection looking at part of the service

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We conducted this unannounced focused inspection to review two requirement notices given at our last focused inspection in August 2016. The requirement notices related to the effective key question which we rated as requiring improvement due to breaches of regulation 12 – Safe care and treatment and regulation 17 - Good governance. Following the inspection in August 2016, the provider submitted action plans telling us how they would make improvements. This also covered areas where we had made recommendations.

We inspected Abbey Court on 12 December 2016 to check whether these improvements had been made. We found areas of good practice:

  • We found staff were taking and recording physical health observations in line with their provider’s policy. Staff were using the modified early warning score tool to identify and action any concerns with a patient’s physical observations.
  • Staff had completed training in modified early warning scores which enabled them to use the tool correctly.
  • A risk assessment protocol had been put in place for the use of the posture support chair. This ensured that staff had an understanding of how to use this safely.
  • There was a procedure in place for recording clinical room temperatures. Staff understood what to do if the temperatures rose above a certain point.
  • Line management supervision was taking place regularly, in line with the service policy.

However,

  • One patient who had an increase modified early warning score did not have this followed up as per the escalation procedure.
  • The clinical room temperatures were not recorded on 11 occasions.
  • Staff told us that they did not feel that they received enough clinical supervision

As we did not review the ratings for the other four domains the ratings for those remain as previously rated in August 2016.

08 August 2016

During an inspection looking at part of the service

We rated Abbey Court Independent Hospital as requires improvement because:

• Staff did not record patients’ baseline physical health observations accurately on modified early warning scores charts. We raised this concern during our last inspection of the service in January 2016, but this had not been adequately addressed. In addition, we found that staff were not monitoring and recording patients’ baseline physical health observations at least once a month, as per provider policy. The service were not completing regular audits or checks to identify whether staff had monitored and recorded patients’ baseline physical health observations.

• The service had no permanent registered manager in post since February 2016. Two senior nurse practitioners had also left the service in the last six months. This effected clinical leadership and support for staff, including access to regular supervision.

• The service had a high staff turnover rate at 16.9%. This could affect continuity of care and familiarity for patients where agency staff were booked to cover staffing shortfalls.

• Staff did not monitor the clinic room temperature. This could affect the shelf-life of some of the medicines stored there.

• There was no protocol in place to guide staff on the correct use of posture support chairs. Patient risk assessments and care plans did not identify how staff would use posture support chairs to support patients appropriately and safely.

However:

• The service had established an effective working relationship with a local GP practice. A GP from the practice ran a weekly ward at the hospital to address patients’ physical health needs.

• The provider delivered a comprehensive mandatory training programme that all eligible staff had completed. Training provided by the five nursing agencies used by Abbey Court was compatible with training provided by Alternative Futures Group.

• The service had employed a full-time occupational therapist in June 2016. They completed specialist functional assessments for patients living with dementia to identify the level of support they required in activities of daily living, such as washing, dressing and eating.

• With the exception of the appropriate use of posture support chairs, staff completed comprehensive risk assessments for all patients. This included identifying triggers that may cause a patient to become agitated or distressed.

• The service met national standards for mix-sexed accommodation; since our last inspection in January 2016, the service had established a female-only lounge area.

• The service did not use rapid tranquilisation or prone restraint. Staff were skilled in the use of de-escalation techniques to support patients who were distressed or agitated.

11-13 January 2016

During a routine inspection

Summary of findings

 We rated Abbey Court as requires improvement because:

  • Neither ward complied with Department of Health (DoH) guidance on same-sex accommodation because there were no separate lounges for male and female patients. The DoH (2015) states that women-only environments are important because of the increased risk of sexual and physical abuse and risk of trauma for women who have had prior experience of such abuse.
  • Staff did not always complete a physical health assessment of every patient, both on admission to the hospital and as appropriate thereafter. Staff did not always fully record patients’ physical health observations. This meant that staff did not have all the information available to make a prompt intervention should a patient’s physical health deteriorate. However, staff did work well with other specialist services, such as GPs, dieticians, physio-therapy and tissue viability to optimise patients’ physical health.
  • Staff did not always explain to patients what their rights were when detained under the Mental Health Act (MHA). Where patient rights were explained, this was not routinely captured in patient care records. Where patients had been identified as lacking the capacity to understand their rights, their nearest relative had not been informed. This was partially mitigated because staff routinely referred patients detained under the MHA to Independent Mental Health Advocates. The advocates regularly attended the wards to offer independent advice and support.
  • At the time of our inspection, there was limited occupational therapy input into the hospital, including a specialist occupational therapist in dementia care.
  • This meant that specialist occupational therapy assessments were not always completed, specifically the ‘functional behaviour profile’ for patients diagnosed with dementia. This assessment was important because it should be used to assess how much assistance a patient with dementia needs to perform activities of daily living, such as washing, dressing and eating. The assessment should then form part of a patients care plan. Senior management assured us that funding had been secured to recruit an occupational therapist in March 2016.
  • The hospital had a high staff vacancy rate at a total of 17%, and a high a long-term sickness and absence rate at 11%. This meant that the hospital relied heavily on nursing agency staff that were not able to perform all the duties of a nurse employed directly by the hospital. Such duties included acting as a named nurse for a patient, which involves completing and regularly reviewing patient care plans and assessments. Consequently, we found that there were not enough named nurses to ensure that all care plans and assessments were fully completed and regularly reviewed thereafter.
  • The hospital identified that any patient who had lived at Abbey Court for more than eighteen months, and had completed their treatment programme, were a delayed discharge. Although the hospital was actively working towards discharging patients to a community setting, four patients on Crossfield ward had been at Abbey Court for over eighteen months.
  • Not all staff members were provided with a regular opportunity to provide feedback into the running of the hospital. This had had an impact on staff-morale.Senior management were aware of this and had plans in place to establish regular team meetings for all staff.

However:-

  • Other than its failure to adhere to guidance on same-sex accommodation, the unit environment reflected best practice in dementia care. It had consistent flooring throughout the communal areas and contrasting handrails. Memory boxes were in place outside patients’ bedrooms. These contained sentimental items, such as family photographs and post-cards, that patients were able to relate to as being significant to them. This helped patient’s identify their own bedroom.
  • The hospital demonstrated a strong commitment to introducing innovative and evidence based ways of working with patients diagnosed with dementia. This included the activating communication potential group for patients who had difficulty communicating their needs verbally. They also used the pool activity level assessment tool to develop personalised activity plans for patients with dementia. The hospital was also committed to developing staff skills and knowledge base in evidence based dementia care. This included providing specialist staff training in the dementia care matters initiative for person centred care, called the ‘footsteps’ training programme.
  • For patients who did not have the capacity to provide meaningful input their care plan, staff used person-centred documents, such as ‘this is me’, to ensure that patients’ views and preferences were captured. This included information about a patient’s hobbies, significant family members and what they liked to eat and drink.
  • Patients’ care records were comprehensive and contained assessments and care plans that related to patients’ individual needs. Staff regularly monitored and assessed patients’ nutritional and hydration needs.
  • All carers we spoke with were positive about the care their relative had received. Carers said that staff were highly skilled and motivated to meet individual patients’ needs.
  • The hospital had formed effective relationships with other agencies that were involved in the care of patients at Abbey Court. This included the local clinical commissioning group, local authority and primary care services. The hospital worked in partnership with a local NHS Trust to deliver specialist dementia training to five local care homes. The hospital was also a member of the Warrington Dementia Alliance Association (WDAA). The WDDA worked together to raise awareness and improve service provision within the local community for patients diagnosed with dementia.
  • There was an established care pathway for patients admitted to Abbey Court. All patients were admitted from one ward based at a local NHS Trust. Three of the consultants psychiatrists employed by Alternative Futures Group worked between the ward and Abbey Court. This meant that patients received continuous care from the same consultant psychiatrist when moving from one service to another.
  • All staff received supervision every six to eight weeks. All staff received an annual appraisal of their work performance. Staff we spoke with said that the senior management team were supportive and approachable.
  • The provider had a comprehensive mandatory training package that included a support essentials programme.  This comprised seven courses, including health and safety, food hygiene, manual handling, fire awareness, infection control, safeguarding, and basic first aid. All staff had completed the support essentials course.  Agency staff training was compatible with that provided by Alternative Future’s Group. 

28 January 2014

During a routine inspection

People spoken with said they have regular meetings and that they are always listened to. People said they can choose the time they have their medication within reason and one person said that they had requested extra heating and a portable heater had been put in their room which they could control.

Other comments were 'although I haven't en-suite facilities I can always have a Jacuzzi bath when I want one, it's no problem for the staff to accommodate this' and 'they help me get dressed and showered when I'd want to.'

People said they had a care plan and one person told us they were very involved in their care plan and felt the staff listened to their views and choices and they are closely involved with their named nurse.

People said they felt very confident about raising any issues regarding their care plan and one person said their relatives were very involved in the care and treatment given to them.

Staff were very positive, motivated and knew the people in their care very well.

We spoke with the people who used the service who said the food was good and they had good choices.

Staff spoken with were enthusiastic about their role and how they looked after people in their care.

11 December 2012

During an inspection looking at part of the service

The purpose of this visit was to follow up on what actions the provider had taken to improve the service since our last visit in June 2012. Following the visit in June 2012 we met with the provider and they sent us regular updates on what action they had taken to meet the compliance actions we had issued in June 2012.

During our visit on 11 December 2012 we saw that improvements had been made in the areas of staff training; assessing the quality of the service that people receive and how information about people's care and treatment was recorded.

14 June 2012

During a routine inspection

People told good things about their life at Abbey Court. They told us that they were involved in making decisions about their care and treatment. Comments included 'I'm happy here' and 'I am settled here.' All of the people we spoke told us that the staff were respectful and if they were not happy about something they could talk to the staff.

Other comments people made included 'staff are marvellous'; 'they look after me well'; 'I like the staff' and 'they are kind.'