05 December 2019
During an inspection looking at part of the service
Gallions View is operated by Bridges Healthcare Limited. The service is a short stay, planned discharge unit operated by registered nurses, health care assistants, a therapy team and a GP. The service offers short term stays of about one month for medically fit patients awaiting placement or next move following an admission to an acute hospital.
We carried out the focused unannounced visit to Gallions View on 5 December 2019 as we had concerns about the safety and effectiveness of the service following a previous inspection in August 2019, where it had been rated as Inadequate. At this inspection we inspected aspects of the safe, effective and well-led key questions. As this was not a comprehensive inspection we did not re-rate the key questions we inspected. The previous ratings remain in place.
Our rating of this service stayed the same as this was the rating applied following the last inspection in August 2019; when it was rated as Inadequate for safe and well-led; and Requires Improvement for effective, caring and responsive.
Throughout the inspection, we took account of what people told us, what we observed and how the provider understood and complied with the Mental Capacity Act 2005.
Our findings from this inspection were:-
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The service lacked effective governance systems to enable it to operate effectively and ensure compliance with the regulations. Environmental risk assessments had not identified out of date medical equipment in an unlocked cupboard and liquid detergent in a food store.
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An inspection by the fire brigade in November 2019 had noted fire safety concerns at this location. The registered manager had raised these safety concerns, relating to the structure of the building, with the landlord. The concerns had to be addressed by 21 May 2020. Staff we spoke with gave different answers in respect of procedures related to the activation of the emergency exits during evacuation of the building in the event of fire. This could have led to delays in evacuating patients in an emergency. Some staff did not know what patients’ personal emergency evacuation plans were or where they were kept.
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Patient sleeping and bathroom areas were not segregated. The service did not safely separate areas for male and female patients in the unit so that the dignity and respect of patients was maintained.
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Staff did not always ensure that medicines were given in line with the instructions of the prescriber. Staff did not routinely record the position of topical patched applied to patients.
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There was no evidence provided during the inspection that a pain assessment tool was in use. This meant that would be difficult for staff to assess if additional pain relief was needed for patients who had difficulty communicating. Staff monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.
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The service had not carried out a formal risk assessment in respect of the need to keep emergency equipment on site.
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The service had not considered the wider needs of patients with dementia or cognitive impairment, who made up a majority of the patient group, and implemented ways to make sure the environment and approach to care better met their needs.
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Staff did not have access to a blood spillage fluid kit to ensure safe clean up of blood and other bodily fluids.
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Patients’ treatment records were difficult to navigate. There was no consistency in recording patient information, which meant that important information could be missed.
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Some staff lacked confidence in moving and transferring patients safely and in completing tissue viability assessments.
However:
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The service had enough staff to care for patients and keep them safe. Staff had training in key skills, although lacked confidence in some areas. 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.
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The service had made some improvements since the last inspection. For example, staff assessed and monitored patients’ skin integrity and worked with tissue viability nurses to in the prevention and the treatment of wounds. Staff gave patients enough food and drink to meet their needs and improve their health, and kept records of this.
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At the previous inspection the registered manager and staff lacked understand of deprivation of liberty safeguards and had failed to apply for authorisations to deprive patients of their liberty. At this inspection we saw evidence that staff had applied for deprivation of liberty safeguards authorisations for those patients that had been identified as lacking capacity and held best interests meetings to ensure that any restrictions were in the person's best interests. The registered manager and staff demonstrated that they understood deprivation of liberty safeguards.
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The registered manager had worked with commissioners of the service and NHS partners to improve standards of care since the last inspection in August 2019. A number of systems were being introduced but would need time to become embedded.
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Staff assessed the needs of all patients. They worked with patients and families and carers to develop individual care plans and updated them when needed. Care plans reflected the assessed needs and highlighted how these needs were to be met. Handover records were clear and included all information staff on the oncoming shift would need to know about patients.
Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, to help the service improve. We issued the provider with four requirement notices. Details are at the end of the report.
Kevin Cleary
Deputy Chief Inspector of Hospitals