Archived: Schoen Clinic York

We rated Kemp Unit at Schoen Clinic - York as requires improvement because:

• The unit did not have enough nurses to meet the needs of the patients. Staffing numbers met the establishment levels however patients told us escorted leave and activities were cancelled or rearranged and post therapy support was not always offered. The unit did not monitor this.
• The service did not meet its safeguarding responsibilities. Staff training on how to recognise abuse was not role dependant and did not meet the requirements specified in intercollegiate guidance. A clear framework which identifies the competencies required for all healthcare staff.
• Feedback from some patients and family members indicated that not all staff treated patients with dignity and respect.
• The unit did not provide the least restrictive environment possible in order to facilitate patients’ recovery. The unit applied blanket restrictions which were not indicated on their blanket restrictions register. Patients could not access the laundry room, sensory room or snug without staff supervision. Patients could only eat their meals in the dining room.
• Governance processes did not always operate effectively. We identified issues with staffing levels, safeguarding, appraisals, blanket restrictions, fire safety and occupational health and safety monitoring.
• Not all staff felt respected, supported and valued, which was reflected in staff survey results reported in September 2019.

However:

• The unit environments were clean. Staff assessed and managed risk well. They minimised the use of restrictive interventions and managed medicines safely.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The unit teams included or had access to the full range of specialists required to meet the needs of patients on the unit. Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives. The unit staff worked well together as a multidisciplinary team and with those outside the unit, who had a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff actively involved patients, families and carers in care decisions.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

We rated Naomi Unit at Schoen Clinic – York as requires improvement because:

• The unit did not have enough nurses. Staffing numbers were not enough when the unit was at full capacity and accepting new admissions. The provider didn’t always meet the minimum staffing levels or have enough staff to cover all patient observations or facilitate group sessions. Trips were cancelled or rearranged.
• The service did not meet its safeguarding responsibilities. Staff training on how to recognise abuse was not role dependant and did not meet the requirements specified in best practice guidance written in conjunction with professional bodies.
• The layout of the unit did not fully ensure patients’ privacy and dignity. Staff measured patients’ blood pressure on the corridor in front of other patients, visitors and staff. Patients were weighed in the small clinic room because it was more accessible than the treatment room. On the main corridor patients signed up to book appointments with staff on the ‘opt in’ board. This meant that other patients and visitors were able to see what patients were attending.
• Governance processes did not always operate effectively. We identified issues with staffing levels, safeguarding, appraisals and development, blanket restrictions, frequency of team meetings, privacy and dignity, fire safety and occupational health and safety.
• The provider had no leadership development or additional training for qualified nurses. Managers did not support all staff with appraisals and supervision.
• Staff did not all feel respected, supported and valued. 
• Staff struggled to describe innovations that were taking place in the service or quality improvement methods that they participated in.

However:

• The unit environments were clean. Staff assessed and managed risk. They minimised the use of restrictive practices and managed medicines safely.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The unit teams included or had access to the full range of specialists required to meet the needs of patients on the unit. The unit staff worked well together as a multidisciplinary team and with those outside the unit, who had a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.
• Staff planned and managed discharge well. They liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.