Archived: John Munroe Hospital - Rudyard

Updated 17 March 2022

John Munroe Hospital – Rudyard is an independent mental health hospital that provides care, treatment and rehabilitation providers for up to 57 adults, aged 18 or over, with long-term mental health needs. Patients may be informal or detained under the Mental Health Act 1983.

John Munroe Hospital – Rudyard is one of two hospitals run by the John Munroe Group Limited.

John Munroe Hospital – Rudyard is registered to carry out the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder or injury
• Diagnostic and screening procedures.

John Munroe Hospital – Rudyard has five wards. Three wards (Horton, Kipling and Rudyard) are in the main hospital building. Larches and High Ash are in self-contained bungalows.

• Horton is a male-only ward that supports up to 16 patients with chronic or complex mental health needs.
• Kipling is female-only ward for up to 16 patients with chronic or complex mental health needs.
• Rudyard is a male-only ward that supports up to 11 patients with organic conditions such as dementia.
• High Ash is a female-only ward for up to seven patients and provides locked rehabilitation.
• Larches is a male-only ward for up to six patients and provides locked rehabilitation. At the time of this inspection this ward had been closed.

The board had decided to close the site by 28 February 2022 and at the time of the inspection Larches was closed and there were only 39 patients at the service.

At the time of inspection, there was a registered manager in place.

We most recently carried out a focused responsive inspection at John Munroe Hospital in August 2021, when we rated the location overall as inadequate. Following the inspection, we told the provider it must take actions to improve.:

What people who use the service say

We spoke to seven people who use the service and one relative.

People who use the service told us they felt safe, were able to raise concerns if they had any and staff treated them with respect and were caring. All seven patients knew about the hospital closing and were anxious about the changes and where they would be placed.

The one relative we spoke to was unhappy about the decision the provider had taken to close the service and was worried about the impact this would have on their relative.

Updated 17 March 2022

John Munroe Hospital – Rudyard is part of the John Munroe Group and is an independent mental health hospital that provides care, treatment and rehabilitation for up to 57 adults, aged 18 or over, with long-term mental health needs services. Edith Shaw Hospital is also part of the John Munroe Group and is located nearby.

The service was most recently inspected in August 2021. We carried out this inspection to follow up on concerns raised at a focussed inspection in January 2021 where the service was rated as inadequate and placed in special measures. We also served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within four days that described how they would address our concerns. The provider’s response did not provide enough assurance that they had acted to address immediate concerns.

Due to the serious nature of the concerns we found during the August 2021 inspection, we used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and imposed additional conditions on the provider’s registration. This included a condition to restrict the provider from admitting any new patients to John Munroe Hospital – Rudyard without the prior written agreement of the Care Quality Commission. This inspection rated John Munroe Hospital – Rudyard as inadequate and placed it into special measures.

On 1 December 2021 John Munroe Group announced to CQC they planned to close the John Munroe - Rudyard site on 28 February 2022 due to the cost of changes and maintenance required to the building and staffing pressures due to the service’s rural location. The commissioners were working with people to find suitable alternative placements.

This inspection commenced on 5 January 2022 and was an unannounced, focussed inspection to see what improvements the provider had made. Our inspection focussed on the concerns we raised to the provider following our previous inspection.

We found improvements in some areas of the service during this inspection, but some serious concerns remained. As a result, the additional conditions on the provider’s registration remained in place. This included a condition to restrict the provider from admitting any new patients to John Munroe Hospital – Rudyard without the prior written agreement of the Care Quality Commission. This inspection rated John Munroe Hospital – Rudyard as inadequate and kept it in special measures.

Our rating of this location stayed the same. We rated it as inadequate because:

• The service was due to close in eight weeks and five out of seven patient records we spoke to did not know their discharge destination.
• Discharge was not adequately planned, co-ordinated and communicated to meet the safe and timely discharge of patients.
• The environment was not always fit for purpose. The building did not meet fire and electrical testing requirements.
• We found maintenance concerns had not always been raised and addressed.
• Fridge temperatures had not been recorded regularly and patient fridges consisted of food that had been opened and not labelled correctly showing when it was opened and when it should be consumed by.
• Not all staff had up to date mandatory training. Training compliance levels were lower than the providers target of 80% for safeguarding training children training, health and safety training, diabetes awareness and manual handling training.
• Staff were not appropriately supervised or supported in line with the provider’s policy.
• Patients did not always have a care plan in place that was detailed and personalised for all areas of care.
• Governance processes in place were not effective and performance and risk were not managed well.
• Staff did not feel respected and valued by senior people in the organisation.

However:

• Staff used approved restraint techniques and patients were not exposed to unnecessary risks of harm and abuse.
• Senior management now reviewed all incident on CCTV to ensure all incident report are an accurate reflection of incidents and all lessons learnt are identified and shared.
• The provider had a process in place to ensure all safeguarding incidents are identified, recorded and reported.
• Ligature anchor points and blind spots were identified, risk assessed and had clear mitigation in place.
• The environment was safe and free from sharp objects and fixtures were secured or removed.
• Waste was now being disposed of appropriately. There were no clinical waste bags and general waste bags stored outside wards or within patient areas.
• Staff followed infection control measures in line with the provider’s policy and visitors were asked to wear clinical face masks as soon as they entered the service.
• Emergency grab bags were secured effectively and had completed checklists in place.
• Staff were aware of the rapid tranquilisation policy
• Medication was stored at the recommended temperature and guidance was in place for what actions staff should take if medication fridge temperatures were out of range.

This service remains in special measures. Services placed in special measures would usually be inspected again within six months. As the provider had decided to close the service CQC will not be going out to reinspect the service.

Updated 17 March 2022

John Munroe Hospital provides two core services:

• Long stay rehabilitation mental health wards for working age adults.
• Wards for older people for mental health problems.

The provider states that it provides a rehabilitation service, however the model of mental health rehabilitation does not meet recognised national guidance.

Wards for older people with mental health problems provide assessment, care and treatment for people whose mental health problems are often related to ageing. This may include a combination of psychological, cognitive, functional, behavioural, physical and social problems.

Wards for older people with mental health problems is a small proportion of hospital activity. We have reported findings for both core services under the long stay rehabilitation mental health wards for working age adults’ section.

Updated 10 November 2020