All inspections: The Farndon Unit - Care Quality Commission

The Farndon Unit is registered with the Care Quality Commission as an independent mental health hospital. The hospital, ran by Elysium Healthcare Limited, accommodates up to 47 female patients over the age of 18 years.

The Unit offers assessment, care and treatment to meet the needs of individual patients with a diagnosis of mental illness, personality disorder and learning disability. The hospital consists of a single building built around an internal garden area. There are five ward areas: Bolero, Courtland, Darcy, Ruby Frost and Aster. The location consists of three core services. Forensic inpatient services, Rehabilitation and Acute inpatient services, we visited 2 wards on this assessment: Ruby Frost ward and Darcy ward (Acute inpatient services).

The service was last rated as good overall (Published January 2023). We carried out our on-site assessment on 25 September and 26 September 2024. This was an unannounced assessment, which means the provider was not told in advance that we would be attending and assessing the service.

During this assessment we looked at 2 key questions and 6 quality statements. Due to assessing 6 quality statements at this visit it means the current rating will remain the same from this assessment. Our new ways of assessing services means that we will visit and assess services more regularly, building a picture of how the service is performing over a period of time.

At this assessment we found the service were maintaining safety of the patient and the environment, patients felt supported by staff and involved in their care and treatment, staff were supported by managers, and appropriate processes were in place to ensure managers had good oversight of the service.

The Farndon Unit is registered with the Care Quality Commission as an independent mental health hospital. The hospital, ran by Elysium Healthcare Limited, accommodates up to 47 female patients over the age of 18 years.

The provider offers assessment, care and treatment to meet the needs of individual patients with a diagnosis of mental illness, personality disorder and learning disability. The location consists of a single building built around an internal garden area. There are five ward areas: Bolero, Courtland, Darcy, Ruby Frost and Aster. The location consists of three core services. Forensic inpatient services, Rehabilitation and Acute inpatient services, we visited 1 ward on this assessment: Bolero ward (Forensic inpatient).

This service was last rated as good overall (Published January 2023). We carried out our on-site assessment on 25 September and 26 September 2024. This was an unannounced assessment, which means the provider was not told in advance that we would be attending and assessing the service.

During this assessment we looked at 6 quality statements across 2 key questions. Due to assessing 6 quality statements at this visit it means the current rating will remain the same from this assessment. Our new ways of assessing services means that we will assess services more regularly, building a picture of how the service is performing over a period of time.

At this assessment we found safety was maintained within the environment, patients felt supported by staff and involved in their care and treatment, managers supported staff, and appropriate processes were in place to ensure managers had oversight of the service.

The Farndon Unit is registered with the Care Quality Commission as an independent mental health hospital. The hospital, ran by Elysium Healthcare Limited, accommodates up to 47 female patients over the age of 18 years.

The service offers assessment, care and treatment to meet the needs of individual patients with a diagnosis of mental illness, personality disorder and learning disability. The hospital consists of a single building built around an internal garden area. There are five ward areas: Bolero, Courtland, Darcy, Ruby Frost and Aster. The Farndon Unit consist of three core services. Forensic inpatient and Acute inpatient and rehabilitation services, we visited 3 wards on this assessment: Bolero ward (Forensic inpatient), Ruby Frost and Darcy wards (Acute inpatient)

The service location was last rated as good overall (Published January 2023). We carried out our on-site assessment on 25 September and 26 September 2024. This was an unannounced assessment, which means the provider was not told in advance that we would be attending and assessing the service.

During this assessment we looked at 6 quality statements across 2 key questions. Due to assessing 6 quality statements at this visit it means the current rating will remain the same from this assessment. Our new ways of assessing services means that we will visit and assess services more regularly, building a picture of how the service is performing over a period of time.

At this assessment we found the service were maintaining safety within the environment, patients felt safe and supported by staff, and involved in their care and treatment, managers supported staff, and appropriate processes were in place to ensure managers had oversight of the service.

The Farndon Unit is registered with the Care Quality Commission as an independent mental health hospital. The hospital, run by Elysium Healthcare Limited, accommodates up to 47 female patients over the age of 18 years and provides mental health inpatient and low secure forensic care.

Our rating of this location had improved. We rated it as good because:

Staff completed and regularly updated thorough risk assessments of all wards areas and removed or reduced any risks they identified. Staff followed infection control policy, including handwashing. We saw that staff regularly cleaned surfaces and ensured alarms were cleaned before providing them to the inspection team.

Staff provided a range of treatment and care for patients based on national guidance and best practice. This included access to psychological therapies, support for self-care and the development of everyday living skills and meaningful occupation. Staff supported patients with their physical health and encouraged them to live healthier lives. Staff used Health of the Nation Outcome Scores to assess and record severity and outcomes. The psychology team used the trauma symptom inventory scale as part of their assessments. Version 2d 24 August 2021 2

Staff had completed and kept up to date with their mandatory training. Overall, 92% of staff had completed mandatory training. The training programme was comprehensive and met the needs of patients and staff and included professional boundaries, safeguarding level 3, infection prevention and control and intermediate life support training. Managers monitored mandatory training compliance rates and alerted staff when they needed to update their training.

Staff carefully planned patients’ discharge and worked with care managers and coordinators to make sure this went well.

The service provided a variety of food to meet the dietary and cultural needs of individual patients and where appropriate were encouraged and where appropriate supported to shop for themselves. Patients had access to spiritual, religious and cultural support and a multi faith room was available.

However:

Eight out of the nine care plans we looked at on the forensic wards did not record the patient voice in their individual care decisions, even though staff had this information.

Healthcare support worker vacancy rates across the hospital were high and meant there was a reliance on bank and agency staff to provide care for patients.

Managers has not ensured that all staff had received an annual appraisal, particularly in acute service. Managers had failed to address heating issues which patients had reported on several occasions.

Our rating of this service went down. We rated The Farndon Unit as Requires Improvement because:

The hospital continued to have challenges in recruiting enough permanent staff and so had a high reliance on agency staff. These staff were not always familiar with the patients and their needs and this presented a clinical risk.
The provider did not consistently follow best practice in the safe storage, control and administration of medicines and clinical equipment or infection control principles.
Staff did not adhere to the provider’s policy around the use of safe and supportive observation practice. Staff did not consistently record or escalate a deterioration in patients’ physical health and staff had not received training in sepsis identification or management.
Staff did not consistently know how and when to report a safeguarding concern or referral to external agencies and we saw variation in how and when staff reported safeguarding concerns.
Patients told us not all staff treated them with compassion and kindness and did not consistently respect their privacy and dignity or understand the individual needs of patients. The hospital did not actively involve families and carers in care decisions.
The hospital did not consistently provide patients with access to information about their care and treatment, how to complain, access to advocacy and appropriate spiritual support.
The hospital did not have robust governance processes in place to support the safe care and treatment of patients within the hospital.

However:

Staff minimised the use of restrictive practice wherever possible and patients were engaged in decisions about their care and treatment.
Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

We rated the Farndon Unit as good because:

We observed positive interactions between staff and patients.
Staff recorded their analysis of incidents to identify themes and we saw examples of learning from incidents.
There was an increase in registered nurses.
The cleanliness of clinical rooms was good and we saw staff checked the emergency equipment regularly.
Staff reported they were supported well after incidents and had a good debrief.
Patients had access to physical healthcare appointments and staff monitored their physical healthcare.
Care plans and risk assessments were up to date and person centred and showed patient involvement.
We saw evidence that showed all patients had psychology input and were offered additional psychology sessions if needed.
Most staff had regular supervision and had yearly appraisals.
Patients were involved in community meetings, ward rounds and morning meetings.
Patients said the hospital had improved from the last inspection and was less chaotic.
Patients had access to advocacy.
Staff morale had improved since the last inspection. Staff said they felt more positive and motivated.

However:

Staff did not always record a rationale for searches.
Some staff we spoke to had limited understanding of the Mental Capacity Act.
Psychology records were difficult to follow and were not consistent where they were kept across the wards.
Recently appointed staff had not received an induction or plan of supervision.

Patients had concerns about food choice and not enough healthy options were provided.

The provider had made significant improvements to the safety and cleanliness of the environment.
The provider had refurbished and refurnished two wards and planned to complete this in all wards.
The provider had installed air conditioning units and fans in medication dispensary rooms so that medicines were stored safely.
The provider had redecorated and refurnished the visitors room. This was available for more patients to use and safe for children to visit.
Staff took action following audits and from listening to patients views to make the hospital safer for patients, staff and visitors.

However:

Some registered nurses did not know how to dispose of medicines safely.
Some staff were not aware of how improvements had been made to the care of patients following learning from incidents.
Some staff and patients did not feel supported following incidents.

We rated Farndon Unit as requires improvement because:

Staff had not checked emergency equipment consistently and some of this was out of date.
Some parts of the wards were dirty and not well maintained. We required improvements to be made to the cleanliness of wards at our two previous inspections.
The provider did not share the findings of incident and complaints investigations with all staff so they could learn lessons from these.
The provider did not deploy staff to safely meet all patients’ needs.
Some medicines were stored at too high a temperature which could affect their safety and effectiveness.
Staff had not recognised that one patient was in long term segregation so the patient had not been reviewed as often as they must be to ensure their safety.
Ten of the 12 care plans we looked at were not personalised and did not record how the patient had been involved in their care plan.
Staff had not always recorded their observations and monitoring of patients’ physical health needs.
Staff had not always followed the Mental Health Act and Mental Capacity Act when treating patients. Audits had not picked up where these Acts had not been followed.
The provider had not updated their policies in line with the Mental Health Act code of practice 2015.
The provider did not make sure all staff received regular supervision and an appraisal.
Five of twenty patients we spoke with told us staff did not knock on their bedroom door before entering which did not respect their privacy and dignity.
Actions agreed at patients meetings were not always followed up and improvements were not made.
The visitors’ room did not offer a relaxed, comfortable and safe environment. Patients were not able to have regular visits as the room was not always available.
All patients were not offered regular, meaningful activities.
Patients told us the food was bland and tasteless. Seasoning and sauces were not provided for all patients. Patients were not offered a range of food that met their cultural and religious needs.
Audits did not always identify where improvements were needed and patients’ views were not always listened to so that improvements could be made.
The provider did not always make sure that action was taken to reduce the risks to staff and patients.

However:

The provider trained all staff in safeguarding adults and children from abuse. Staff knew how to make a safeguarding referral and did this when needed.
The provider had made sure that ligature points were reduced to help keep patients safe.
Each patient had their risks assessed and plans showed how staff supported the patient to manage these.
Patients had a physical health check on admission.
Patients were offered a range of psychological therapies.
The multidisciplinary team worked well together to meet patients’ needs.
We observed all staff treated patients with kindness and compassion.
Staff knew the individual needs of patients and how to support them.
Patients knew how to make a complaint and these were investigated.
The provider took part in national quality improvement programmes and research to improve the quality of the service.

On ward A, the ensuite bathrooms were dirty and in need of refurbishment.
On-going staffing issues affected the hospital’s ability to meet patients' needs, especially around access to leave and activities.
Six out of 11 patients we spoke with told us that access to activities, including the resource room and gym, was limited due to the number of staff available. One patient told us they had only been able to access the resource room twice and could never use the gym.
The hospital had experienced difficulties recruiting staff but it had an active recruitment plan. The hospital used a high number of agency and bank staff.
Staff did not always give emergency alarms a timely and appropriate response, which put patients and staff at risk.
Care plans did not show clear involvement of the patients and were not personalised. We found care plans that staff had not re-written since 2013 and 2014. We identified this issue on our last inspection, but the service had not addressed it.
We found areas of concern around practices relating to the implementation of the Mental Health Act.
Medication was authorised at high doses up to 150% and 200% of British National Formulary limits on authorisation forms. The responsible clinician (RC) had not prescribed medication at these levels on all medicine charts.

However,

No staff had worked for a continuous 24-hour period. This had been an issue at the last inspection.
The hospital had introduced a staffing assurance tool to try to manage staffing issues.
The hospital had reviewed and updated its policies and procedures following two serious incidents.
The hospital had developed an audit to assess emergency responses. As this was very new, outcomes of the audit were not yet available.
Staff completed physical health checks in line with national guidance. We found that patients received a physical health check on admission and annually thereafter.
We observed positive interactions between staff and patients during our visit.
Patients told us that the staff were approachable, good and caring.

We rated Raphael Healthcare Limited (The Farndon Unit) as good because:

Different professionals worked well together to assess and plan for the needs of patients.
There were good risk assessments in place and good programmes of care that were aimed at providing specialist rehabilitation for the patients.
Advance statements were completed with patients who wanted them. Mental capacity assessments were routinely completed. Patients were advised of their rights under the Mental Health act.
Patients were provided with a comfortable and modern facility.
The service undergoing an improvement programme in order to raise the quality of care it provided.

New managers had been recruited and demonstrated the skill and experience needed to drive forward further improvements. Patients were provided with care and support from a range of professionals in order to give them good recovery opportunities.
Physical health care needs were routinely addressed and patients were supported to manage their physical health.
The service listened to patients’ ideas and feedback then made some changes to the way they ran the service because of this.
Systems were in place that allowed managers to audit the quality of care.
Supervision and annual performance reviews were routinely held between staff and managers and were largely up to date.
The service was responsive to the needs of staff.
There was an on-going recruitment programme in order to fill vacancies.
We saw that Raphael Healthcare Limited (The Farndon Unit) had addressed the issues of non-compliance from the November 2014 inspection.

However, we also found that:

Care plans were not written in a way which reflected patient views. They identified the support that each patient needed but were written in a prescriptive format rather than a person centred format
There were gaps between November 2014 and February 2015 when many of the care plans and risk assessments had not been regularly updated
Nursing staff felt that occupational therapy staff could communicate better with them after patients left their creative art groups and took their pieces of art and craft to their rooms, because sometimes they were heavy or contained sharp items that could pose a risk to staff and patients.
Staff, patients and managers told us that staff had worked 24 hours on a number of occasions but managers had taken action to ensure staff were available for overtime when staff did not attend for work at short notice.

We inspected this service following concerns raised by a CQC Mental Health Act Reviewer who visited ward A on 30 October 2014. We visited wards A and B only during this inspection. We spoke with 17 people who used the service and eight staff on the wards. We also met with the hospital director, deputy hospital director, the responsible clinician, the clinical director and the Mental Health Act administrator.

We found that improvements were needed to ensure the service was safe. We found the provider had policies and procedures in place to protect people from abuse or harm. However, we identified some ligature risks on ward A and found that people who used the service did not feel safe.

Improvements were needed to ensure the service was effective. We found that restrictions were placed on all people who used the service.

We observed that most staff interacted well with people who used the service and people told us that staff were caring. However, the privacy and dignity of people who used the service was not always respected.

During this inspection we did not assess whether the service was responsive or not.

Improvement was needed to ensure the service was well led. Systems were in place to ensure that regular audits were completed to measure the quality of care. However, this was not always reflected in the service that people received or the support given to staff.

We undertook a joint visit on 09 December 2013 with colleagues from the Mental Health Act Commission, to look at staffing levels on each ward and to assess whether the staff numbers, skill mix and gender mix were suitable. The team comprised of two compliance inspectors, a Mental Health Act Commissioner and an expert by experience. (This is a person who has had personal experience of the type of service provided for patients at the Farndon Unit.)

Prior to our visit we reviewed all the information we had received from the provider, from other professionals and from people who used the service. During the visit we spoke with 8 people who lived at the service, 3 care workers and 3 qualified nurses. We also looked at some of the records held in the service including the care files for 3 people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We visited again on 14 January 2014 to conclude the inspection process and to look at the documentation relating to staff numbers and how staff were deployed in the hospital.

Before we conducted this inspection visit, we looked at all the information we had about the service. We also requested that a professional advisor assist us to complete the inspection.

Following our visit we spoke with a person who had recently conducted a Mental Health Act 1983 monitoring visit. They will produce a separate report.

We briefly visited all the wards and spoke with people. Some people expressed a wish to speak with us in more detail on a one to one basis. The professional advisor spoke with some people and we also spoke with some.

During our visit we spoke with 9 patients individually, 3 members of ward staff, a consultant psychologist and 3 members of the management team.

Most of the patients told us that they were happy with the care and support they received. One patient told us, "The staff do help me and sometimes seem to go out of their way to make things better for me." Another patient told us: "I was given information about my rights and I understand why there are things I can't do.'

One patient told us they did not like being in the hospital because they were feeling well. They added, 'When I am ill, this is the best place to be.'

Some patients we spoke with told us that they did not like it if their Section 17 leave was cancelled especially if others still got it. Section 17 of the Mental Health Act 1983 makes provision for certain patients who are detained in hospital under the Mental Health Act 1983 to be granted leave of absence.

Patients told us that there were a range of activities they could engage in and they had activities staff as well as occupational therapists. The favourite activity appeared to be visiting the caf' on site. This was open for a limited amount of time according to staff availability.

Most of the patients we spoke with told us that they did feel safe and they had no concerns about their welfare. One patient told us "I feel safe here." However, another person said they felt worried being on their ward because several other people were unsettled.

People told us they were given the opportunity to give formal feedback at ward meetings and patient group meetings.

As part of our inspection we visited two wards and spoke with six patients, six staff and looked at records of incident monitoring, staff deployment and Section 17 leave frequency.

We found that there were sufficient numbers of suitably qualified, skilled and experienced persons employed In order to safeguard the health, safety and welfare of patients.

One patient commented, 'I have leave every week, my activity sessions are never cancelled.' Another patient told us, 'There is a good balance of male and female staff, they go out of their way to help you here.'

During our visit we spoke with five patients. Four out of the five patients told us that they were happy with the care and support they received. One patient told us, 'Staff are very caring.'

Patients told us that staff supported their health and personal care needs and took prompt action to get them medical attention when it was needed.

Four out of the five patients we spoke with said they felt safe in the hospital and knew how to raise any concerns they might have. One patient told us, 'Staff do a really good job.'

Two patients told us that when restraint techniques were used they had been used appropriately and safely. Another patient told us, 'When I need restraining the staff help me feel safe.'

Four patients we spoke with told us that often there was not enough staff on duty on their wards. Two of the five patients we spoke with told us that at times unplanned activities got cancelled due to other staff commitments.

During our visit we spoke with a number of patients. Most of the patients told us that they were happy with the care and support they received. One patient told us: 'Staff are good they understand where you are coming from'. Another patient told us: 'I have been given information about my rights.' One person said that this was the best place she had been to for care and treatment.

Some patients we spoke with told us that they did not like it when their Section 17 leave was cancelled. Section 17 of the Mental Health Act 1983 makes provision for certain patients who are detained in hospital under the Mental Health Act 1983 to be granted leave of absence. One person had made a complaint about this and another patient told us: 'I hope they don't change my leave again this week.'

When we asked patients about the quality of food we received a mixed response. Some patients told us that the food was fine. Other patients that we spoke with told us that they were not happy with the food and the portion size. Patients told us that there was a range of activities that they could engage in.

Most of the patients we spoke with told us that they did feel safe and they had no concerns about their welfare. One patient told us 'I feel safe here.' One person told us that they are given the opportunity to give formal feedback.

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.

These older reports are from our old approaches to inspection, including those from before CQC was created.

The Farndon Unit

All Inspections

During an assessment of Acute wards for adults of working age and psychiatric intensive care units

During an assessment of Forensic inpatient or secure wards

During an assessment of the hospital overall

10 and 11 August 2022

During an inspection looking at part of the service

11 January 2022

During a routine inspection

5-6 December 2018

During a routine inspection

28 - 29 November 2017

During a routine inspection

12 July 2017

During an inspection looking at part of the service

13 - 15 March 2017

During an inspection looking at part of the service

21 and 22 December 2016

During an inspection looking at part of the service

15 February 2016

During an inspection looking at part of the service

13th – 15th May and 5th June 2015

During a routine inspection

6 November 2014

During an inspection in response to concerns

9 December 2013 and 14 January 2014

During an inspection in response to concerns

14 October 2013

During a routine inspection

28 January 2013

During an inspection looking at part of the service

29 August 2012

During a routine inspection

17 February 2012

During a routine inspection

Mental Health Act Commissioner reports

Reports under our old system of regulation