• Mental Health
  • Independent mental health service

Castle Lodge Independent Hospital

Overall: Good read more about inspection ratings

Noddle Hill Way, Bransholme, Hull, North Humberside, HU7 4FG (01482) 372403

Provided and run by:
Barchester Healthcare Homes Limited

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Castle Lodge Independent Hospital can be found at Barchester Healthcare Homes Limited. Each report covers findings for one service across multiple locations

During an assessment under our new approach

Date of assessment 7 February to 8 February 2024. Castle Lodge Independent Hospital is a specialist independent mental health service based in Kingston Upon-Hull. It is part of Barchester Healthcare. The service provides treatment and care for individuals detained under the Mental Health Act, Mental Capacity Act or as an informal patient experiencing cognitive impairment or enduring mental health illness. The service has 15 beds over 2 wards: Bluebell Ward –10 bed ward for men aged 50 years+ and Primrose Ward – 5 bed ward for women aged 50 years+. A new Registered Manager, had taken over the leadership of the service since the last inspection. We rated safe environments as outstanding because we found that risks were assessed using a balanced and proportionate approach; people were cared for in a safe environment and the service were exceptional at meeting people's care and treatment needs; facilities, equipment and technology were well-maintained. Leaders and staff considered how environments kept people safe from physical and psychological harm. We also found that people received care, treatment and support that was evidence-based and in line with good practice standards. Risk assessments were holistic and person centred and enabled staff to respond to risk in a positive way that protected peoples rights and dignity. The service took a proportionate approach to imposing restrictions on people. People received information about care and treatment in a way they could understand. People's capacity and ability to consent was taken into account and this included consultation with others such as carers, families and advocates. The service promoted people's independence, health and wellbeing by enabling choice and control. Staff provided access to a range of in-house and community activities to support people build and maintain relationships. People’s care, treatment and support promoted equality and the service worked to remove barriers and protect people’s rights.

26 and 27 June 2019

During a routine inspection

We rated Castle Lodge Independent Hospital as good because:

  • The service provided safe care. The ward environments were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices but when necessary they reported, reviewed and learnt lessons from any incidents.
  • The service managed medicines safely, involved patients where possible in all decisions and followed good and clear procedures when covert medications were required.
  • The service followed good practice with respect to safeguarding and had an effective working relationship with the safeguarding team.
  • 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 multidisciplinary team and with those external to the ward.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005 and made every effort to involve patients in decisions about their care.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and fully understood the individual needs of patients considering their background, work history, likes and dislikes and by engaging with people in their lives.
  • They actively involved patients and families and carers in care decisions and kept families fully informed when incidents occurred.
  • Staff viewed complaints positively and encouraged feedback to improve the service and outcomes for the people who used it.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.
  • Leader were visible in the service and well known, they took the time to understand individual needs and encouraged innovative practice to deliver the best outcomes.
  • Staff and services were recognised, valued and rewarded for delivering high quality care.

However:

  • The provider needed to ensure there are sufficient qualified, competent and skilled staff to meet the needs of the patients, at all times.
  • The provider needed to ensure that patients could have free access to outdoor space and lockable bathroom doors.
  • The hospital needed to ensure cleaning records are completed and kept up to date.
  • Improvements were required to enhance the environment for people living with dementia.

17/01/2017

During an inspection looking at part of the service

We rated Castle Lodge Independent Hospital as good because:

  • The stages of the admission process were available to referrers, patients and their relatives and staff were involved in a pre-assessment to ensure the hospital could meet the needs of the patient. Following a twelve week assessment period that included two formal review meetings, treatment plans were agreed which showed targets for progression in recovery.
  • Assessments completed after admission were comprehensive, timely and informed care planning. Care plans were personalised, recovery focussed and used patients’ chosen name. Care plans records were relevant to individually identified needs and showed evidence of regular review.
  • Staff engaged with patients in a respectful manner and offered reassurance and support to patients who were showing signs of distress. Patients told us they felt safe at the hospital, that staff were always nearby and treated them well. Carers’ spoke of their loved ones being happy and that the care they saw was good.
  • Staff were clear about the need to safeguard vulnerable adults in their care and saw safeguarding as everyone’s responsibility. We found positive communication between the hospital and the local safeguarding authority.
  • Staff knew their responsibility to be open and explain to patients if something went wrong. The carers we spoke with were confident the patients and themselves would be contacted if anything untoward happened. We saw the duty of candour policy followed at the hospital.
  • Staff received regular clinical and managerial supervision that they reported as being both challenging and supportive. The staff compliance rate for supervision was 100%.
  • The staff we spoke to were committed to their work and wanted to deliver patient care that was the best it could be. Staff spoke of being supported by the hospital manager and the senior managers in the organisation who they knew.
  • Staff received regular training and appraisal that supported their development. Against provider target of 85%, the hospital showed staff training compliance of 95% and compliance with appraisal was 89%.
  • Staff felt able to raise concerns without fear of victimisation, they knew about the organisations whistleblowing policy, and that they could contact external organisations to report concerns.

However,

  • We found issues with safe systems in the management of medicines that were not identified in the hospital’s regular medicines audits. Not all staff involved in administrating medication worked to hospital protocols, there were discrepancies in medicine stock levels and medicines were not all disposed in a timely way. Whilst agreed following capacity assessments and best interest meetings, the administration of covert medication did not always follow consultation with a pharmacist, nor was it regularly reviewed in multidisciplinary team meetings.
  • Barchester consultant psychiatrists that provided on-call cover for the hospital when the locally based consultant was on leave may not be able to attend in the event of a psychiatric emergency within 30 minutes. The Royal College of Psychiatrists accreditation standards for inpatient older adults mental health November 2014, state that an identified duty doctor should be available to attend within 30 minutes in the event of a psychiatric emergency.
  • Whilst wide enough for a wheelchair to pass through, the door into the garden from the female lounge was not wide enough for a patient to propel herself with their hands on the wheels of the chair.
  • The hospital had no dedicated space for therapeutic activity. Activities took place in communal lounges, dining areas and the garden.

16th to 18th February 2016

During a routine inspection

We rated Castle Lodge Independent Hospital as requires improvement because:

  • The minimal levels of qualified nurses on shift were low for the mix of patient needs; the delayed recruitment of a clinical lead that had been of ongoing concern for over six months contributed to this.
  • A lack of onsite cover from the responsible clinician, made it particularly difficult when a patient in the hospital needed detention.
  • The range of mental health professions in the multidisciplinary team was too narrow to meet the psychological needs of patients in the hospital.
  • The complex systems in place within medicine folders, involved a great deal of paperwork for each patient, increasing the risk of a medicines error.
  • Care planning documents were not easy for staff to navigate, creating the possibility that important detail and patient choices could be missed.
  • There was no clear model of care, care pathway and limited evidence-based practice.
  • Patients were not always supported to maintain independent living skills.
  • Key decisions about care made at ward rounds did not routinely involve patients, their relatives or an independent advocate.
  • There was no clear criteria for admission to or discharge from this service.
  • The hospital described an inappropriate discharge pathway: moving patients from detention under the Mental Health Act 1983 onto Deprivation of Liberty Safeguard under the Mental Capacity Act 2005, this highlighted a lack of understanding of the legislation.
  • Capacity to consent and best interest decisions were not comprehensively completed or documented; the narrative as to how the assessment had been conducted was not evident from the documentation.
  • Advanced decisions in place did not follow a transparent process, nor was recording completed with the detail required.
  • Staff did not understand their individual responsibility in relation to the Mental Capacity Act 2005 to be able to apply this in practice.
  • Barchester policies had not been updated or re-written to ensure compliance with the Mental Health Act Code of Practice.
  • The hospital did not analyse reported risks to patients and staff effectively. There were no structures to ensure staff and managers learned lessons from incidents or complaints.
  • Training record systems offered a lack of clarity for training figures; only 45% of staff had completed infection control training in the past year and no staff members were in date with equality and diversity training.

However,

  • Staff knew patients well and responded to their needs, engaging with patients in a genuine, caring and respectful manner.
  • Patients and carers became involved in the initial comprehensive admission assessment, which included physical health checks and care planning.
  • Individual patient risk assessments including falls, linked to individual care planning for each patient.
  • Patients received one to one time with staff, talking or engaging in activities.
  • Staff understood their responsibilities to safeguard the patients in their care.
  • The head chef worked closely with staff to meet specific dietary needs and patients had facilities to drinks and snacks 24 hours a day.
  • Patients and relatives could become involved in community meetings about the service.
  • The staff team on night duty spoke positively about their work and the support they received from each other.
  • Detention paperwork was correctly completed, up to date and stored appropriately.
  • Staff records included documented evidence that all staff had received an annual appraisal and regular managerial supervision.

03 August 2015

During an inspection looking at part of the service

We found

  • The clinic room was dirty and the floors were not clean.
  • Single use medicine pots were being washed by hand which was not infection control. These were lying dirty in the sink. This was despite the infection control training being at 93%. 
  • The drug fridge was open with the key in the lock. This was rectified immediately.
  • Mandatory training figures were lower than expected. 

However

  • The ward complied with same sex accommodation guidance. Staff knew the incident reporting process.Pressure ulcer risk assessments were completed on admission. Debriefs for staff occurred after incidents and learning was fed back to them via meetings or supervision.
  • The hospital director had sufficient authority to increase staffing numbers should they be required to deliver enhanced nursing care.

24 April 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people had complex needs, which meant they were unable to tell us their views and experiences. We spoke with several people who used the service who were able to verbally communicate with us and one relative and they told us they thought the service provided a good standard of care and support.

We spoke with several people who used the service and they told us they could make choices about going out and taking part in activities. Comments included, "I have been baking today", "I like to go for walks and to the shops" and "They (the staff) are very nice and kind."

We spoke with one relative who told us their concerns had been listened to and action taken to address them. They commented, "The management and staff are wonderful and they have sorted all of the concerns I had" and "My husband is doing well and seems settled" and "We have just had a carers meeting and everyone is extremely happy with the care and support offered."

We looked at various written documentation that included the care files of people who used the service, the environment and staff records. We saw that these had improved since our last visit.

23, 24 January 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people had complex needs, which meant they were unable to tell us their views and experiences. We spoke with one relative and they told us they thought the service provided very good care and support. They commented, 'The personal care is excellent', "The staff are lovely, all of them" and "If I have any concerns I could go to any of the staff and they listen."

We observed staff interacting with people who used the service and this was carried out in a sensitive way. We observed lunch time and staff assisted those who needed help, this was done at their pace.

We spoke with one relative who told us the home is clean, warm and comfortable. However, during a tour of the building we noticed that some fire doors appeared to have a gap where the lock was of more than the recommended 3mm. We spoke with the Fire Department and they advised that they would visit on 8 February 2013 and assess the situation.

We looked at various written documentation that included the care files of people who used the service, the environment and staff records. We saw that these were not always up to date or accurate.

15 July 2011

During an inspection looking at part of the service

We were able to chat to patients during the course of our visit. No concerns were raised by patients about their experience of living at Castle Lodge. One detained patient said that they were happy with their care.

8 April 2011

During an inspection in response to concerns

When talking to patients about how they were involved in decisions about their care they told us; 'we can have drinks and snacks when we want', 'I can choose to do what I want' and 'we get up and go to bed when we want'.

People told us that staff were helpful. Some comments included, 'staff help us, but sometimes we have to wait a long time' and 'the staff are good to us and help us lots'.