Farmfield

Updated 3 October 2023

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the service. At our last inspection we rated the provider as requires improvement.

At the previous inspection in July 2021 the provider was found in breach of 5 regulations and issued with requirement notices. We told the provider to make the following improvements:

• The provider must ensure that it maintains a balance between the maintenance of safety and providing a least restrictive environment appropriate to each of its services. The provider must ensure that patients are able to keep their belongings safe, locked away and are able to access them when they need them. The provider must ensure the dignity of patients when using such items as anti-tear clothing. Patients must be treated with dignity and respect. Regulation 10 Safe care and treatment.

• The provider must ensure that the acute wards seclusion rooms comply with the Mental Health Code of Practice. The provider must ensure patients have easy access to fresh air and outside space. All premises and equipment used by the service provider must be (c) suitable for the purpose for which they are being used and (e) properly maintained. Regulation 15(1)(c) and (e) Premises and Equipment

• The provider must ensure it identifies and manages all risk for patients in the acute wards. Care and treatment must be provided in a safe way for service users. Regulation 12 Safe care and treatment.

• The provider must ensure that the range of therapeutic activities is available to meet patients’ needs in the secure wards in accordance with guidance from National Institute of Health and Care Excellence. Regulation 9, Person Centred Care.

• The provider must ensure that it stores keys on the medium and low secure wards safely, so keys can be found easily in the event of an emergency. Regulation 12 Safe care and treatment.

We found at this inspection the provider had made the improvements we told them to make. We found the provider was identifying restrictive practice and acting to remove them when possible. Patients on the acute wards did not have to go through the secure entrance every time they left or returned to the hospital. The provider had supplied secure lockers for patients to keep their belongings safe. The provider had addressed the issues identified with acute ward seclusion rooms and patient access to outdoor space and fresh air. Staff received a risk assessment on all patients referred to the hospital, and patients admitted to the acute wards had a comprehensive risk assessment completed within 24 hours of admission. There was a full range of therapeutic activities available to patients. The provider had organised the storage of keys on the secure wards so that the correct key could be found without delay.

What people who use the service say

The patients we spoke with on the Acute and PICU wards told us staff were supportive and helpful. They also told us they were involved in planning their care and that the doctors and nurses always discussed treatments with them. For example, if they needed to change medication.

Patients on the forensic wards told us they received good care and felt the staff had helped them move on. Some patients said they found the ward routines helpful and enjoyed taking leave from the hospital. Patients said they were seen regularly by the psychiatrist and had access to advocates and Mental Health Act solicitors as needed. Some patients said when at times they felt intimidated by other patients, this had been dealt with appropriately by staff and said they felt safe on the wards. Patients told us they were complying with their care and treatment with a view to discharge.

Patients knew how to complain and raise concerns about their care with hospital staff, advocacy services and the CQC (Care Quality Commission).

Updated 3 October 2023

Farmfield Hospital provides Forensic medium secure, low secure and acute inpatient services for adult male patients. It has 80 beds over 7 wards.

Forensic services:

• Rusper is a medium secure ward with 10 beds focusing on admission, assessment and treatment.

• Hookwood is a medium secure ward with 10 beds focusing on admission, assessment and treatment.

• Capel is a medium secure ward with 10 beds focusing on admission, assessment and treatment.

• Newdigate 1 is a low secure ward with 11 beds focusing on admission, assessment and treatment.

• Newdigate 2 is a low secure ward with 10 beds focusing on admission, assessment and treatment

The acute wards for working age adults consist of two wards:

• Brockham is a 14 bedded admission ward.

• Faygate is a 15 bedded admission ward.

Our rating of this location ​stayed the same​. We rated it as ​requires improvement​ because:

• We inspected 2 domains which meant for those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

• Staff had not always taken action when they identified items that needed replacing in the emergency bag.

• Staff had not always completed the Drugs Likely for Misuse register.

However:

• Staff had received the training they needed to care for the patients admitted to the hospital.

• Staff received information including a risk assessment of all patients before they were admitted to the hospital and staff completed a risk assessment within 24 hours of a patient being admitted.

• The provider was actively identifying restrictive practice and taking action to remove unnecessary restrictions that had been placed on patients.

• Staff understood how to safeguard patients and took action when someone was at risk of abuse.

• The provider had an effective governance system in place that identified any issues and managers shared learning with the whole team.

Updated 3 October 2023

• Our rating of this service stayed the same. We rated it as good because the service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. Staff completed comprehensive risk assessments for all patients and regularly reviewed them.

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and 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 had good knowledge of their patients.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Staff were responsive to feedback from patients about their care and the ward environment.
• The service was well-led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Some physical health monitoring equipment had not been checked or maintained in a timely way.

We rated this service as good.

Updated 3 October 2023

Our rating of this service ​stayed the same​. We rated it as ​requires improvement​ because:

• Staff had received the training they needed to care for the patients admitted to the hospital.

• Staff received a risk assessment of all patients before they were admitted to the hospital and staff completed a risk assessment within 24 hours of a patient being admitted.

• The provider was actively identifying restrictive practice and taking action to remove unnecessary restrictions on patients.

• Staff understood how to safeguard patients and took action when someone was at risk of abuse.

• The provider had an effective governance system in place that identified any issues and managers shared learning with the whole team.

However:

• Staff had not always taken action when they identified items that needed replacing in the emergency bag.

• Staff had not always completed the Drugs Liable for Misuse register.