Archived: Brook House

Updated 27 September 2016

Brook House is an independent hospital providing care and rehabilitative support for up to 12 adult men experiencing complex mental health needs in a locked rehabilitation unit. The hospital also had use of three flats in the service next door, from the same provider, to offer a move on service for patients to develop their independence prior to discharge. However, the additional flats were closed at the time of the inspection, as building work was underway. The provider is Deepdene Care Limited. Deepdene Care provides services at seven other locations across England, mainly residential care homes for adults with mental health needs. Brook House is the only independent hospital operated by Deepdene Care.

Brook House has been registered with CQC since February 2013.It is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Diagnostic and screening procedures
• Treatment of disease, disorder or injury

The hospital is located in a residential area of Old Trafford.

The hospital has a registered manager who is also the controlled drugs accountable officer.

CQC last inspected Brook House in December 2014 as part of the pilot to trial new inspection methodology; the hospital was not rated as part of the process. CQC made recommendations for the hospital to consider including Mental Health Act documentation requirements, medicines storage and discharge planning with patients.

Prior to the inspection the provider contacted CQC to inform of their plans to close Brook House as a hospital. Within the presentation from the registered manager and compliance manager, they informed us that due to a reduction in occupancy and changes in commissioning arrangements they propose redesigning the service to be a nurse led mental health service attached to Clifton House, the residential service next door. The registered manager of Clifton House would be responsible for the expanded service. At the time of inspection, staff were aware of the proposed changes and consultation was underway, particularly with staff whose roles were at risk. Patients were not aware of the proposed changes, the registered manager advised that the provider had informed commissioners first and then following this, patients would be informed following guidance from commissioners. The compliance manager hoped that the redesigned service would be open by September 2016.

Updated 27 September 2016

We rated Brook House as requires improvement because:

• The hospital was not compliant with the Mental Health Act Code of Practice, published 2015. The required policies within the Code of Practice were not written and available. One prescription card had medication prescribed for a patient as required (PRN) which was not authorised on their T3 form. Staff had not received training in the revised Code of Practice. The responsible clinician frequently changed the days of the ward rounds at very short notice, meaning patients were not prepared for their meeting, the advocate was not present and if family or external professionals were due to attend they would not have been aware of the change.
• Staff did not consider the Mental Capacity Act in their everyday practice. Capacity assessments were not taking place in accordance with the Mental Capacity Act and there was no consideration of best interest processes.
• The hospital could compromise the safety of patients. The environmental risk assessment was not fit for purpose and did not identify the ligature points within the building or advise staff of how to mitigate the risks. The hospital manager was not following the ligature and self-harm policy. There was a sign on the clinic room door to inform staff that oxygen was stored there, however the oxygen was stored in the staff office. There was no emergency medication available for the overdose of benzodiazepines. The prescription cards were illegible. This posed a risk of staff administering the wrong medication to patients. There were no care plans in place for patients prescribed antipsychotic medication above the British National Formulary limits.
• Staff did not receive the training relevant to their role. Mandatory training attendance levels were below 75% for the majority of courses, including emergency first aid and safeguarding adults. Staff did not receive training on the Human Rights Act. Specific training for the needs of the patients were low, including diabetes awareness at 21% and drug and alcohol awareness at 53%
• The provider was not complying with the Duty of Candour Regulation. The policy did not specify that people should receive a written apology. Staff we spoke with were not aware of the duty of candour.
• Care was not patient centred. Restrictive practices were in place including locking the cutlery away and not allowing detained patients to hold their own lighters. A patient had been deskilled, who was previously cooking independently and living in the annex. They had to move back into Brook House due to building works, had all meals cooked for them, and were in a hospital with locked doors. Care plans were nurse led and it was not clear what actions patients needed to take to progress from the service. Staff had not referred a patient identified as requiring psychology. There was no written information provided to patients upon admission to assist with orientation within the environment. Community meetings had a disproportionate amount of staff present compared to patients and actions from previous meetings were not always completed.
• The hospital was not well led. There was no evidence of learning from incidents at a hospital or provider level. Policies at the hospital were all out of date, mainly from 2013. However, the provider had more recent versions in place, which the hospital had not made available to staff. Staff felt unable to progress within the organisation with limited opportunity for development including no opportunity to complete National Vocational Qualifications. There were no examples of staff surveys or any other methods or forums for staff to give feedback about the service.

However:

• The hospital was homely and welcoming and provided the facilities to promote patients' recovery including access to drinks and snacks at all times and areas to spend in quiet. Patients had keys to their bedrooms and had their own mobile phones. The majority of patients had progressed within their time at Brook House and were pursuing activities in their local community independently. The occupational therapy assistant had created a plan to show times of activities available in the local community.
• We observed warm, positive and nurturing interactions between staff and patients. All patients reported staff were friendly, caring and respectful. Patients had access to advocacy. Families were involved in ward rounds and care programme approach meetings if patients wished. Patients gave feedback about the service via service user questionnaires and community meetings.
• The hospital manager was following the complaints policy and investigations were completed in a timely manner. Information was on display to inform patients how to complain.
• Staff had appraisals and supervisions. Regular team meetings took place. Debriefs were taking place following incidents.
• The provider’s recruitment and selection policy, dated July 2015, complied with the Health and Social Care Act 2008(Regulated activities) Regulations 2014 in relation to recruiting staff that are fit and proper.

Updated 27 September 2016