Our rating of this location stayed the same. We rated it as requires improvement because:
We continued to rate safe and well led as requires improvement as there were regulatory breaches at the last inspection and the provider was still working on their action plan. We re-inspected safe but did not inspect well led. We did not inspect responsive, and its rating remains good.
The rating for effective went from good, to requires improvement. The service did not meet legal requirements relating to appropriate premises to meet person-centred care. Therefore, the regulatory breach limited the rating to requires improvement.
We were assured that rating of caring was still good so have reinstated the rating for this key question.
The environment on Leo and Hopkins ward was not designed to meet the clinical needs of the people in the service. We found that people’s sensory needs were compromised due to the environment.
The new electronic reporting system for people’s activities was not yet fully embedded. This meant that written records did not always clearly reflect the number of hours people were engaged in activity in any given week.
There were high levels of observations on the wards. Some people always required two or three staff to be with them. This impacted on the noise levels and increased activity of the wards. Although, it was clear that additional support was to keep the people safe.
Although interactions between patients and staff during observations were positive. During our on-site visit we found that interactions between staff and patients were limited and there were sometimes long gaps between interactions.
It was not always clear in people’s records how staff had used people’s positive behavioural support plans to de-escalate potential incidents. We could see from speaking to staff, people and reviewing CCTV that these methods were used during incidents, but staff had not always written it down.
Four out of the five carers we spoke to raised communication as an issue. This was in the context of the telephone not always being answered, messages not being passed on and community leave arrangements not being communicated in a timely manner. However, most carers were happy with the care their loved ones received. They were given the opportunity to be involved in people’s care and invited to relevant meetings.
However:
The environment was clean and tidy. Due to the people that resided on Leo and Hopkins ward, the environment needed ongoing redecoration. Managers had a plan of when this would happen, and funds were allocated to complete this.
Staff completed risk assessments on admission and updated them when necessary. This was usually weekly but more often if risks had changed.
Staff were clear that they were happy to raise concerns without fear of retribution to protect people from abuse and poor care.
Staff were kind to people and treated them with dignity and respect.
Staff knew people well and were able to tell us in detail about individual people’s needs, likes and dislikes.
People’s care plans were individualised and detailed. The written records told staff how a person liked to be cared for, often from the person’s perspective. Sensory assessments were completed to ensure care plans clearly reflected the person’s needs and provided the rationale for why they were managed in a particular way.
There was a wide range of planned activities available both on and off the ward. People had individualised activity plans that gave people choice, whilst maintaining a balance of low stimulus and more stimulating activities.
For people who were nearing discharge, the ward worked closely with transition teams for extended periods to ensure discharge went smoothly.