Archived: The Huntercombe Hospital Norwich

The Care Quality Commission carried out an urgent and focussed unannounced inspection of Huntercombe Hospital on 16, 17, 18, 20, 21, 24, 28 November 2017 and 7 December 2017.

The Care Quality Commission has a duty under Section 3 of the HSCA to consider the immediate safety and welfare of the young people at the hospital. We looked at this throughout our unannounced inspections.

We found significant and immediate concerns that required immediate action. We worked closely with NHS England and The Huntercombe Group senior management team to ensure that immediate concerns for the health and wellbeing of the young people were acted on. We took enforcement action to stop any new patients from being admitted to Huntercombe Norwich. The Huntercombe Group made the decision to remove all of the young people from the hospital. NHS England found alternative placements for all the young people. We then took further enforcement action to ensure that services could no longer be provided at this location.

During inspection we found that:

• The hospital did not manage risk to young people effectively or protect young people from carrying out acts of self-harm and aggression. Staff failed to manage the safety of the hospital’s physical environment. As a result, young people had access to dangerous items as weapons or for acts of self-harm.Although staff reacted to incidents on the wards, they did not take action to prevent incidents occurring or escalating.

• The hospital did not learn lessons from serious incidents or take effective action to reduce the risk that a similar event would happen again.Staff failed to report some incidents in line with the provider’s policy. Managers did not review or investigate all serious incidents robustly, openly and transparently. When the provider did investigate an incident, it did not take effective action to address the findings of these investigations. Despite giving repeated assurances that it had put measures in place, serious incidents of a similar nature continued to happen.

• The hospital did not take the necessary action to protect young people’s physical health.We identified several incidents were staff did not carry out physical health observations on a young person whose breathing had been compromised, following an act of self-harm.The provider failed to ensure there was adequate emergency oxygen on the wards at all times.

• The provider failed to ensure that there was a sufficient number of skilled and experienced staff on the wards to meet the needs of the young people.

• Staff did not always treat the young people with dignity and respect.

• The ward environment was unclean and without an effective system in place to maintain cleanliness.

We rated Huntercombe Hospital Norwich as requires improvement because:

• Some staff reported that at times the wards were left with no registered nurse for a short period. This was when one nurse took a break and the other nurse responded to an emergency on another ward. We raised this concern with the provider who gave the concern immediate attention to prevent this from happening again.
• We did not see evidence of review of supportive observations. For instance, one record showed a patients increasing risk but there was no clear plan of how to manage this risk. There was no evidence of review of the patient’s observation levels in the ward round held by the Consultant in light of the increased risk. Lack of review of increasing risks could lead to a serious incident.
• Staff did not follow their own policy that says there should be a review of patient’s supportive observations daily and there should be a daily entry in the patient’s clinical notes specifically relating to supportive observations.
• There was no audit of supportive observation or of rapid tranquilisation. The provider did not identify concerns relating to these areas.
• Staff did not complete any of the reviewed rapid tranquilisation records correctly. None of the rapid tranquilisation physical health monitoring was completed in line with the hospital’s own policy or best practice.
• Prescribing of rapid tranquilisation was not in line with the hospital’s own policy.
• Staff did not routinely assess individual patients capacity and competency and they lacked understanding of this process.
• Two patients under the age of 16 had capacity assessed under the Mental Capacity Act 2005 (MCA). Only patients over 16 years old should be assessed using the MCA. Those under 16 years old should have competency assessed by a doctor using the Gillick assessment.
• In three cases, the Responsible Clinician (RC) did not update the patient’s consent form.
• Some staff were not clear about the role of the independent mental health advocate (IMHA). It was not clear from patients’ notes whether any patients had been referred to the IMHA.
• We checked nine seclusion records and we found that seven were not completed in line with the MHA code of practice.
• Male patients’ had to walk passed the female bedrooms to access the communal areas, or be escorted outside around these areas. This was a breach of the Mental Health Act code of practice regarding mixed sex accommodation.
• Some policies provided by the Huntercombe Group were out of date, such as the Supportive Observation Policy, which was due to be reviewed in September 2016.

However:

• Between 19 June 2016 and 19 December 2016 there were 893 restraints used on 52 different patients. There were 1688 restraints in the previous 6 month period between June and December 2105. This was a reduction of 795 restraints. Although there had been a period of time in 2016 with bed number reductions, this represented a downward trend and demonstrated that the hospital was working to reduce the number of restraints.
• The hospital had mitigated some safety observation risks by installing mirrors and CCTV in the main ward areas.
• We reviewed 12 patient records and all had a comprehensive risk assessment completed on admission, which staff had updated regularly.
• Care records showed that doctors completed physical examinations for all 12 patients whose records were reviewed, and there was evidence of ongoing review of patient’s physical health needs.
• We saw innovative practices such as the use of staff own dogs with patients in a therapeutic environment. This was risk assessed for both the dogs and patients safety.
• The occupational therapy assistant had completed a course of camouflage make up and had introduced sessions with patients who requested it.
• The hospital invested in specialist training courses for staff.
• Rainforest ward received a participation certificate for the Quality Network for Inpatient CAMHS, awarded in October 2016.
• There were strong links with the school, which was located on site, and had received a ‘good’ rating from Ofsted. The school and ward communication was well established and every effort was made to encourage school participation and a variety of educational courses were available.

Senior managers provided effective leadership within the hospital.