Archived: Garrow House

Inspected but not rated

We inspected Garrow House on 12 and13 June 2017. This was an unannounced, focused inspection looking at the well led and safe domain to find out whether the hospital had made the required improvements since our last focused inspection on the 09 November 2016.

Following our inspection in June 2017 we did not rate the safe and the well led domains we found:

• Staff used a safe staffing tool to ensure there was always enough staff to provide 1:1 time. Planned activities both on and off the unit were rarely postponed as the occupational therapist and activities co-ordinator were not counted in the staffing numbers.
• Staff compliance with their mandatory training was at 97% overall. This was above the mandatory training compliance target of 80%. Managers ensured staff received regular and comprehensive supervision.
• We reviewed weekly and monthly medication audits and found the provider had detected some gaps in administration records. Staff documented clear actions to make improvements where there were identified shortfalls. The hospital had made improvements to staff compliance with the recording of physical health checks for patients who received rapid tranquilisation and monitoring side effects for patients who received high doses of anti-psychotic medication.
• The hospital had maintained improvements needed to ensure that the equipment used for providing care and treatment was safe for use.

However:

• There was no record of an initial risk assessment for patients who administered their own medicines. Although this had not affected patient’s safety, it meant staff had not fully followed the hospital policy for self-administration of medicine.
• Following the administration of rapid tranquilisation Staff had not consistently recorded the level of consciousness in particular when a patient had refused to have their observations taken. Although this had not affected patient safety, it did mean that staff had not always followed the hospital policy for the recording of observations.
• During inspection we found that two of the five medicine records we reviewed had gaps in administration signatures. This meant that staff had not always maintained an accurate record of the treatment patients had received.
• The hospital had an environmental ligature risk assessment completed in February 2017; this risk assessment did not include the study room on the second floor. This meant that not all potential ligature points within the hospital had a completed risk assessment. The hospital had a separate environmental risk assessment that included cables and wires. We were concerned that having two separate risk assessments addressing ligature risks could be confusing for staff.
• The hospital emergency ‘grab bag’ was cluttered and felt heavy to lift. Although this was accessible in the clinic room the equipment in the bag included an oxygen cylinder, we were concerned that staff might have difficulty finding and carrying equipment they needed in an emergency.
• Patients we spoke with felt agency staff did not always respect their privacy and sometimes sat reading or using their personal phones in communal areas.
• The hospital did not have an identified seclusion room and had when necessary used the ‘chill out’ room to seclude patients. The hospital had considered if a dedicated seclusion room was necessary for the hospital in the future, as the ‘chill out’ room does not comply with the Mental Health Act 1983 and it’s code of practice which states what the specifications of a seclusion room should be.  

We inspected Garrow House on 09 November 2016. This was an unannounced, focused inspection to find out whether the hospital had made the required improvements since our last comprehensive inspection on 4-5 January 2016.

Following our inspection in November 2016 we have not changed the rating in the safe domain but have changed the overall rating from good to not rated because:

• The hospital had not made all the improvements needed to ensure that staff followed the hospital policies and procedures for the safe management of medication.

• The hospital did not carry out checks on the quality of staff compliance with the policies and procedures for the safe management of medicines. This included checks regarding staff administration of medication, records for patients prescribed ‘when required’ medication and records for patients who administered their own medication.

• The hospital did not carry out checks regarding staff compliance with monitoring physical health checks for patients who received medication for rapid tranquillisation and side effect monitoring for patients who received anti-psychotic medication.

• Because of what we found, we issued the hospital with a warning notice in November 2016 in relation to regulation breaches in the governance arrangements.

• In the warning notices, we told the hospital they needed to take action to improve staff compliance with hospital policies and procedures for the safe management of medication and improve the management and quality assurance of the service by 28 February 2017.

• We will be returning to the service after this date to check the hospital has made the improvements.

However;

• The hospital had made some improvements following our last inspection in January 2016. This included action that ensured that all equipment used for providing care and treatment was safe for use, reviewed policies, and procedures about their medicines practices and arranged for most staff to attend additional medicines management training.

• The physical health lead ensured staff carried out regular and comprehensive checks on patients’ physical health

• Staff reported medicine related incidents and apologised to patients when errors occurred. Staff acted quickly to ensure the impact of any errors did not cause any harm to patients.

We rated Garrow House as good because:

• Staff assessed and managed the risk to patients from ligature points (places where patients might tie something to strangle themselves) effectively.
• Managers kept a register of risks that provided an overview of identified risks in the service.
• Staff assessed patients’ needs before and on admission, including physical health assessments.
• Staff reviewed records regularly and completed good up to date risk assessments. Care plans were recovery orientated and personalised.
• Staff were respectful and caring when they spoke with patients and patients spoke in a positive way about staff. They said they felt listened to and staff treated them with dignity and respect. All patients and carers felt fully involved in care decisions.
• There was an effective incident reporting system in place and staff knew how to report incidents. Staff had de-briefs and shared  learning from incidents.
• Staff understood their responsibilities in relation to the duty of candour. All patients knew how to complain and managers ensured patients had an apology.
• The service made appropriate checks when they recruited staff and all newly recruited staff received a local induction. Staffing levels were safe and recruitment was in progress for vacancies.
• All staff felt supported by managers and had access to regular supervision and appraisal.

However:

• Staff did not ensure that all equipment used for providing care and treatment was safe for use and didnot follow the correct policies and procedures for the safe management of medicines.
• Staff did not fully document care and treatment in relation to seclusion and restraint.
• Staff did not always ensure patients’ rights under the Mental Health Act 1983 (MHA) were explained to them.
• There were difficulties recruiting nurses, which meant the service relied on the regular use of agency staff to maintain safe staffing levels.
• Not all policies were up to date.