27 and 28 January 2015
During a routine inspection
Staff did not receive the training they needed to ensure they were able to care for patients safely and appropriately. Qualified nurses had not completed medication competency training for more than a year. None of the staff had completed the required basic or intermediate life support training within the last 12 months. Neither had any staff member received an annual performance appraisal in the last year.
The provider had not notified the Care Quality Commission of all events they should have. There had been four safeguarding concerns reported to the local authority and one incident that was reported to the police, since March 2014. All of these should have been notified to the Care Quality Commission by the provider but were not. There was no registered manager in place had not been for some time. In addition, the manager of the service was not aware that six monthly fire drills had not been carried out for over a year.
However, the service had a good safety record. There were enough staff on duty to meet patients' needs. Environmental and individual risk assessments were carried out and action taken to manage the risks identified. Staff knew how to recognise and report potential abuse in order to protect patients and others.
The needs of patients were assessed in detail. This included their physical as well as mental health needs and there was on-going monitoring of needs. Staff were very kind and caring. Care was individualised and person-centred and patients were involved in developing their own care and support plans.
Patients took part in a range of activities and groups both inside and outside the service. They were encouraged to develop their skills and independence. Staff focussed on patients’ recovery and helped them build on their strengths.
There were systems in place to review and monitor the quality of care provided. Action was taken when shortfalls were identified and improvements were made.
Mental Health Act responsibilities
At the time of the inspection two of the four patients were detained under a section of the Mental Health Act 1983 (MHA). The use of the MHA in the service was mostly good. MHA documentation was generally compliant with the Act and Code of Practice.
Capacity and consent assessments had been carried out for the two patients who were detained under the MHA. However, in the documents of one patient the section of the form for them to sign, indicating their consent to the treatment plan had been left blank. As a result the consent status of the patient was unclear.
Staff explained patients’ rights to them in a way they understood and repeated this often. Patients had access to an independent mental health advocate who could support them.
Mental Capacity Act and Deprivation of Liberty Safeguards
Most staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. However, their understanding of the legislation and how it affected their everyday clinical practice varied. Some staff had a good understanding of the MCA. Others could not clearly explain the details of a mental capacity assessment and what a deprivation of liberty meant.
The service was making an application for a Deprivation of Liberty Safeguards authorisation in respect of one informal patient about whom there were concerns about his capacity to consent to care and treatment.