Archived: Garrow House

Updated 16 October 2020

Garrow House was a specialist tier four personality disorder inpatient hospital that admitted female patients from the Yorkshire and Humber region. The hospital had 12 beds. At the time of inspection, the hospital was providing care and treatment for four patients.

Garrow House had been registered with the Care Quality Commission since 13 December 2010, as a shared enterprise between Turning Point and an independent Mental Health hospital. Garrow House changed their registration on 1 April 2019 to have Turning Point as the sole provider. They were registered to carry out two regulated activities:

• assessment or medical treatment for persons detained under the Mental Health Act 1983, and
• treatment of disease, disorder, or injury.

The hospital de-registered with the CQC on 27 August 2020.

Garrow House was part of the Turning Point Group. The hospital did not have a registered manager or controlled drug accountable officer in place at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager has a legal responsibility for meeting the requirements and associated regulation in the Health and Social Care Act 2008. An accountable officer is a senior person, required by law, with the responsibility of monitoring the management of controlled drugs to prevent mishandling or misuse.

The hospital had been inspected on one previous occasion under their current registration. A comprehensive inspection of the service was conducted 28 and 29 January 2020. The service was rated inadequate overall; receiving an inadequate rating in the safe and well led domains; requires improvement in the effective and responsive domains and a good rating in the caring domain. The service was placed in special measures and a section 29 warning notice was served under Regulations 12 and 18 of the Health and Social Care Act (Regulated Activities) 2014. This stated that care and treatment was not provided in a safe way for service users; the provider did not do all that was reasonably practicable to mitigate any such risks; or ensure that there were enough suitably qualified, competent, skilled, or experienced persons with appropriate training to enable them to meet patients’ care and treatment needs in a safe way.

The provider also received requirement notices under Regulations 13 and 17 of the Health and Social Care Act (Regulated Activities) 2014 following the 28 and 29 January 2020 inspection. This was because systems and processes were not established or operated effectively to prevent abuse of service users and were not necessary to prevent, or proportionate to the risk of harm posed by patients. They did not ensure that they assessed, monitored and improved the quality and safety of the service, or the health, safety and welfare of patients and others who may be at risk within an appropriate timescale.

We did not review all of the concerns raised within the previous inspection report as this was a focused inspection conducted in response to risk information, not a comprehensive review of the service. While there had been areas of improvement, there continued to be concerns regarding the provider’s response to patient risk, the training of staff and the provider’s governance processes. We also had concerns regarding the suitability of the premises and the provider’s delay in sending statutory notifications to the CQC and local authority.

Updated 16 October 2020

We are placing Garrow House in special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We rated Garrow House as inadequate because:

• The service did not provide safe care. The ward environments were not safe and did not have enough nurses and doctors that knew the patients well. There were high vacancy rates and high uses of agency staff. Skill mix on shifts was not always appropriate for patient needs and there were high numbers of unfilled shifts. The service did not always implement fire safety procedures effectively and staff training, and induction did not keep patients safe from avoidable harm.
• Staff did not manage risks well. They did not manage medicines safely; there were errors and omissions in the prescribing, administering, recording and storing of medicines. The service used restrictive practices, there was no clinical rationale for restrictions and staff did not consistently apply them. Staff did not always check patients’ risk assessments and some staff gave items to patients that they then harmed themselves with. Managers did not ensure all service risks were identified on the risk register and control measures were not always implemented.
• The service was not well led, and the governance processes did not ensure that ward procedures ran smoothly. The service had staffing issues that impacted on the safe care and treatment of patients. Systems for record keeping, access to IT systems, mechanisms to monitor incidents, policies, medicines management and audits were not implemented effectively. The service did not manage patient safety incidents well. Incident review meetings to review trends did not occur regularly. Meeting minutes did not clearly record clinical discussion or detail actions. Staff debriefs did not always occur following incidents
• Staff training was not well managed. Eleven of 14 mandatory courses were below provider target. Safeguarding training on how to recognise and report abuse did not meet the expected levels identified in best practice guidance. Only 36% of qualified nursing staff had in date safeguarding training. Staff, including managers, could not confirm if training in the Mental Health Act 1983 and the Mental Health Act Code of Practice was mandatory. Induction training was not delivered consistently. Staff had not all completed all elements of the induction programme, and dialectical behavioural therapy training had not been delivered since 2018.
• Patients said that staff were too busy at night to support them and that some agency staff did not understand their needs or how to care for them. There was limited involvement with families and carers. Staff did not have formal feedback tools to gather feedback about the service from families or carers.
• Staff provided a range of treatments suitable to the needs of the patients, but these could not be delivered in line with national guidance about best practice because of staffing issues.

However;

• Staff understood the individual needs of patients and respected their privacy and dignity.  Staff actively involved patients in decisions about the service and their care. 
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. The service worked to a recognised model of mental health rehabilitation for patients with personality disorder. Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• Staff included or had access to a full range of specialists required to treat patients on the ward. Staff worked well together as a multidisciplinary team and with those outside the service who would have a role in providing aftercare.
• Managers ensured that staff received supervision and appraisals. The service environment was clean.

Updated 13 May 2020