Ellern Mede Barnet

Our rating of this location went down. We rated it as requires improvement because:

• The providers systems and processes to manage medicines safely were not always implemented and followed to keep patients safe.
• Staff did not always carry out and document patient observation checks as per hospital policy.
• When rapid tranquilisation was administered, staff did not always carry out physical health observations as per hospital policy. Staff did not always report incidents of rapid tranquilisation.
• The service had a high number of vacancies and a high use of agency staff. Agency staff did not always know the patient’s care plans or receive training for the specific patient cohort which impacted upon the quality of care. At the time of inspection, the occupational therapist position and the clinical psychologist position were vacant. Due to these vacancies there were limited activities and therapeutic support offered to patients. The two consultant psychiatrists working at the hospital were both adult psychiatrists.
• Ward areas were small. Ward areas also had blind spots.
• The service was not always using information gathered through its governance systems to ensure that the quality of services were improved with appropriate mitigations taken with regards to risk. Whilst the service participated in clinical audit, they did not always use the findings to create action plans and make improvements. Team meetings did not always follow the set agenda points. This could lead to important information not being shared with the wider team. Discharge plans were not always documented within patient records. Induction checklists for agency staff did not document that agency staff were shown the ligature points on the ward.

However:

• Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service. Managers were approachable for patients, families and staff.
• Most staff felt respected, supported and valued. They said the hospital provided opportunities for development and career progression for most team members. Managers supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff. Staff could raise any concerns without fear.
• Patients, carers and staff were able to provide feedback to the service. Managers used this feedback to make improvements.
• Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected patient’s assessed needs, and were personalised, holistic and recovery-oriented. Staff involved patients and their families in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff assessed patient risk well.
• Staff ensured that had good access to physical healthcare and supported them to live healthier lives. Staff used recognised rating scales to assess and record severity and outcomes.
• Permanent staff treated patients with compassion and kindness. Permanent staff understood the individual needs of patients and supported them to understand and manage their care, treatment or condition.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The hospital and provider had a named safeguarding lead.
• The service managed patient safety incidents well. Staff recognised most incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.