Malsis Hall - Mental Health Care Home with Nursing

Updated 17 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of one senior specialist, one inspector, and two medicines inspectors.

Service and service type.

Malsis Hall – Mental Health Rehabilitation Service is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Malsis Hall – Mental Health Rehabilitation Service is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. A manager had been recruited and they were in the process of applying to register with CQC.

Notice of inspection

The inspection was unannounced on both days of the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with six people who used the service about their experience of the care provided. We spoke with 11 members of staff including the nominated individual, service manager, quality manager, care home manager, clinical lead nurse, a nurse, the activities co-ordinator, and four recovery workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included six people's care records and multiple medication records. We looked at four staff files in relation to recruitment and supervision. A variety of other records relating to the management of the service, including policies and procedures were also reviewed.

Updated 17 January 2024

About the service

Malsis Hall Mental Health Rehabilitation Service is an independent mental health hospital and care home with nursing based in Glusburn, North Yorkshire.

This report refers to the care home element of the registration only. The independent mental health hospital is inspected and reported on separately, but falls under the same provider and location address.

The service supports up to a maximum of 19 younger adults with mental health needs; there are three named units across four separate buildings. Worth Suite has six en-suite bedrooms with a shared communal kitchen and one large self-contained apartment. Pullen Cottages is two attached buildings with four self-contained apartments in each building. Frost House has four individual self-contained apartments. At the time of the inspection there were 16 people living in the service.

People’s experience of the service and what we found:

Risks to people’s health and safety were not consistently assessed and mitigated and staff were not always clear about risk management plans. Whilst some improvements had been made to medicines management since the last inspection, the service was failing to ensure there were adequate and robust systems in place to ensure policies were followed and ensure detailed care records were in place for staff to support people with their medicines.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Safeguarding procedures were in place and were followed to help keep people safe. Incidents and accidents were recorded and analysed although post-incident debriefs did not always take place.

Staffing levels were sufficient within the service although there had been instances of staff not being appropriately deployed. Safe recruitment procedures were in place.

Staff received a range of training, supervision and appraisal. Staff said they felt well supported by the management team. People’s nutritional needs were assessed although records of people’s food intake were not consistently completed.

Staff were kind and caring, but restrictions to people were not always robustly documented to show their human rights had been upheld. In most cases, people were involved in decisions relating to their care.

Care plans did not always contain detailed and person-centred information about people's needs and the care they received. Reviews were not consistently completed People had access to a range of activities although the monitoring of these needed improving.

Systems to assess, monitor and improve the service were not suitably robust. The provider needed to ensure systems were operated to ensure consistent compliance with our regulations. People, staff and other stakeholders were regularly consulted to their views on the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement in April 2021. We found the provider was in breach of 6 regulations relating to Failure to Notify CQC of incidents, failure to provide safe Care and treatment, staffing, safeguarding, consent and good governance.

At this inspection some improvements had been made, but the provider remained in breach of regulations relating to safe care and treatment, consent and good governance.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, and staffing, but also to follow up on breaches of regulation identified at the last inspection in 2021. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safe care and treatment, consent and good governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Updated 23 April 2021

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. However, care plans were nurse led and often written using clinical language that did not reflect the patient voice. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have 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, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• 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.
• The service worked to a recognised model of mental health rehabilitation. It was well led and the governance processes ensured that ward procedures ran smoothly.

However,

• The service did not always provide safe care. At the time of our inspection none of the registered nurses were trained in immediate life support and the provider did not offer this training or have the equipment that would be needed to carry out immediate life support. We spoke to the provider about this at our inspection feedback. Following on from this we were informed that this training had been booked for all registered nurses. However, this had not yet taken place. The wards had enough nurses and doctors, although this was not always clear from the staffing rotas as they did not indicate which ward staff were allocated to for the the shift.The ward environments were clean. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• We found one incident where the provider failed to notify CQC of a police incident which they were legally obliged to do so. This meant that CQC was not always aware of incidents that had occurred in the service. We found that the incident report log had gaps in some areas.