Archived: Constance House Hospital

Updated 27 October 2017

Constance House Hospital is part of Sequence Care Limited.

Constance House is an independent hospital situated in Enfield, North London. It provides care and treatment for up to 11 female patients with learning disabilities, along with autism, mental disorder or challenging behaviours. At the time of our inspection, there were four patients. One patient was on leave and staying with their family. One patient was detained under the Mental Health Act.

The CQC previously inspected Constance House in August 2015. At the last inspection, the service received an overall rating of good.

Updated 27 October 2017

CQC previously inspected Constance House in August 2015. At the last inspection, the service received an overall rating of good.

At this inspection we rated safe as requires improvement and well-led as requires improvement. Therefore, we have rerated the service as requires improvement overall.

We found the following issues that the service provider needs to improve:

• The provider had made a decision not to address any environmental concerns until it had made a decision about the future of the service.
• The premises were not safe for patients. Ceramic tiles had been removed from the wall. This left the sharp, hard edges of the other tiles exposed.
• The premises were not clean. Carpets throughout the hospital were severely stained. In one patient’s flat, there were stains on the walls.
• The provider had not reported a safeguarding concern to the local authority safeguarding team. The service had not sent any notifications of abuse or allegations of abuse to the CQC since September 2016 even though an incident of abuse had occurred.
• The provider did not investigate serious incidents and complaints in detail, which meant that patients may have been significantly affected in some way and that opportunities where missed to learn from incidents and complaints and reduce the likelihood of reoccurrence.
• The provider did not have effective governance systems in place to assess, monitor and improve the quality and safety of the service. The provider had not addressed recurring issues identified in audits of cleaning and environmental safety. The provider did not have a local risk register that reflected concerns raised by the staff.

However, we also found the following areas of good practice:

• Staff produced comprehensive positive behaviour support plans for each patient. These plans clearly identified the triggers for patients’ challenging behaviour and details of how staff should respond.
• Staff knew patients very well. They understood patients’ routines, rituals and indicators of increased risk and could respond by reassuring patients before situations escalated
• Staff were trained in de-escalation techniques and used verbal de-escalation before physical interventions. Physical interventions involved a minimal use of force. Staff did not use seclusion or rapid tranquilisation.
• There were sufficient staff on duty at all times. Staff spoke positively about their experience of working at the service and found the hospital manager to be supportive and approachable.
• The provider had systems to ensure staff were up to date with mandatory training. Staff received regular supervision and annual appraisals.

Updated 27 October 2017