Review of compliance. Hertfordshire Partnership NHS Foundation Trust Harperbury. East. Region: Harper Lane Radlett Hertfordshire WD7 9HQ

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1 Review of compliance Hertfordshire Partnership NHS Foundation Trust Harperbury Region: Location address: Type of service: East Harper Lane Radlett Hertfordshire WD7 9HQ Hospital services for people with mental health needs, learning disabilities and problems with substance misuse Rehabilitation services Date of Publication: August 2011 Community based services for people with mental health needs Overview of the service: Harperbury provides services to adults and children who may have learning difficulties, autistic spectrum disorders or mental health problems. Services are provided in a variety of individual units Page 1 of 14

2 and wards. Harperbury is registered for the activities of treatment of disease, disorder or injury and of assessment or medical treatment for persons detained under the Mental Health Act Page 2 of 14

3 Summary of our findings for the essential standards of quality and safety Our current overall judgement Harperbury was meeting all the essential standards of quality and safety. The summary below describes why we carried out this review, what we found and any action required. Why we carried out this review We carried out this review to check whether Harperbury had made improvements in relation to: Outcome 01 - Respecting and involving people who use services Outcome 07 - Safeguarding people who use services from abuse Outcome 10 - Safety and suitability of premises How we carried out this review We reviewed all the information we hold about this provider. What people told us During this review we did not seek the views of people using the service or their relatives. What we found about the standards we reviewed and how well Harperbury was meeting them Outcome 01: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run The provider is compliant with this outcome. People who use the service are supported to understand and make their own choices about their care and treatment. There are procedures in place which ensure that, as far as possible, people are involved in their care planning and are involved in how services are delivered. Outcome 07: People should be protected from abuse and staff should respect their human rights The provider is compliant with this outcome. Staff are aware of the policies and procedures in place which ensure that people are protected from the risk of abuse and have their rights protected at all times. Outcome 10: People should be cared for in safe and accessible surroundings that Page 3 of 14

4 support their health and welfare The provider is compliant with this outcome because people who use the service can be sure that assistance would be forthcoming in an emergency and that appropriate fire safety practices are followed. Other information Please see previous reports for more information about previous reviews. Page 4 of 14

5 What we found for each essential standard of quality and safety we reviewed Page 5 of 14

6 The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential standard. Compliant means that people who use services are experiencing the outcomes relating to the essential standard. A minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard. A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary improvements are made. Where there are a number of concerns, we may look at them together to decide the level of action to take. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety Page 6 of 14

7 Outcome 01: Respecting and involving people who use services What the outcome says This is what people who use services should expect. People who use services: * Understand the care, treatment and support choices available to them. * Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support. * Have their privacy, dignity and independence respected. * Have their views and experiences taken into account in the way the service is provided and delivered. What we found Our judgement The provider is compliant with Outcome 01: Respecting and involving people who use services Our findings What people who use the service experienced and told us During this review we did not seek the views of people using the service or their relatives. Other evidence During our visit to the Harperbury site on, 16 and 21 June 2011, we found that the staff in some units actively sought to involve the people using the service in their care, while staff in other units did not seek to establish the individual's wishes. Following these visits we requested that the provider took specific action to address these issues. During this review we were provided with evidence to demonstrate how people's individual needs and choices are now being sought and met. For example, all care plans are being reassessed to ensure that everyone using the service has a plan that is in a format accessible to them. In addition protected periods of time have been established when people can discuss their plans with their named nurse. Processes have been put in place to audit care plans to evaluate the impact of these new ways of working and to ensure the processes are implemented consistently for all people.this is so that people are supported to be as fully involved as possible in their care planning. At our last review we raised concerns about some people not being able to move freely Page 7 of 14

8 around the unit as some internal doors were locked. We have been provided with evidence that internal doors in each unit will now only be locked where people's risk assessments demonstrate that this is necessary. All staff at the service have received a variety of updated training, and their understanding of the information provided at these sessions has been checked through a variety of approaches. For example, during team briefings, staff's understanding of person centred care planning is now checked to ensure people's individual needs are being met. Additional senior staff are being identified to work alongside care staff and will challenge any institutional practices so that people are supported in an individual way. To address the concerns raised at our last review about dignity and respect, staff have received updated training in promoting respect and dignity and 'Respect Posters' have been displayed throughout the trust to clarify this for staff. The provider is seeking to ensure people using the service have their views listened to about the daily running of the units and engagement groups are being set up where people's comments will be recorded and used to inform the running of the service. However, as these groups are not yet operational, it is not possible to assess their effectiveness. Posters showing people how to access advocacy services have also been displayed in the units and the provider has requested that all advocates visiting the service ensure that they seek the person's views on a range of areas including satisfaction with the food provided. Any comments received will be passed to the management team who will review these anonymous comments and take any action necessary to ensure people's satisfaction is maintained. As these initiatives are not embedded into the service as yet, it is not possible to evaluate the impact they might have. Our judgement The provider is compliant with this outcome. People who use the service are supported to understand and make their own choices about their care and treatment. There are procedures in place which ensure that, as far as possible, people are involved in their care planning and are involved in how services are delivered. Page 8 of 14

9 Outcome 07: Safeguarding people who use services from abuse What the outcome says This is what people who use services should expect. People who use services: * Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld. What we found Our judgement The provider is compliant with Outcome 07: Safeguarding people who use services from abuse Our findings What people who use the service experienced and told us We did not seek the views of people about this outcome at this review. However, during our visit on 16 June 2011, no concerns were raised by people or their relatives about safeguarding. Other evidence There is currently an ongoing investigation about the service under Hertfordshire County Council's Joint Agency Safeguarding Procedures. However, the investigation has established that there are no concerns about current safeguarding procedures at the service and that people are being protected from the risk of abuse. During this review evidence has been provided to show that all staff have received updated training and information about all aspects of the safeguarding procedures they need to follow. Every member of staff has signed a declaration stating they have understood the safeguarding and whistle blowing process and new posters are being displayed to clarify the whistle blowing process so that people can be protected from abuse at all times. The trust has established a new senior staff post and the member of staff recruited has responsibilities for safeguarding practices across the service and will ensure, through monitoring and taking appropriate action, that staff continue to follow good safeguarding practice. We were told that regular unannounced visits by managers continue to take place across the service, where staff understanding of safeguarding and whistle blowing practices are checked. Page 9 of 14

10 During this review evidence has been provided that staff's access to key policies, including those on safeguarding and whistle blowing, has been streamlined. A new folder containing these policies has been placed in all units and this folder also gives staff clear guidance on how to access all policies on the trust internal web site. This ensures staff have access to information when they need clarification so that people using the service are protected from abuse at all times. Our judgement The provider is compliant with this outcome. Staff are aware of the policies and procedures in place which ensure that people are protected from the risk of abuse and have their rights protected at all times. Page 10 of 14

11 Outcome 10: Safety and suitability of premises What the outcome says This is what people should expect. People who use services and people who work in or visit the premises: * Are in safe, accessible surroundings that promote their wellbeing. What we found Our judgement The provider is compliant with Outcome 10: Safety and suitability of premises Our findings What people who use the service experienced and told us We did not seek the views of people about this outcome at this review. Other evidence At our visit to the service on 21 June 2011, we identified concerns that there was not an integrated alarm system that all staff could use to summon assistance. During this review the provider has submitted evidence that demonstrates that a new alarm system is being installed which will mean that all units are now linked to an emergency system for the protection of the staff and people using the service. It is planned that this new alarm system will be operational by 16 August During our visit on 21 June 2011, we were told by staff on one unit that all the individual alarms, issued to staff to be used to summon assistance, were broken. During this review we were provided with evidence to demonstrate that at each staff shift handover meeting a review of personal alarms now takes place to ensure that all alarms are working properly for everyone's safety. During our previous review we noted that internal fire doors were wedged open in the units. The provider has submitted evidence that all areas of the service have been audited to ensure fire safety is maintained. As a result of our review and the internal audit, door closure systems have been installed in units so that fire doors will close automatically in the event of a fire, to ensure the safety of everyone on the site. During our previous review we identified concerns that, when people needed two members of staff to escort them from a unit, this left only one member of staff on duty on that unit to support the remaining people, which was not always a safe number. The Page 11 of 14

12 provider has submitted evidence that this situation has been resolved and that safe levels of staffing are now in place. For example, a review of staffing numbers and staff deployment has as taken place and more bank support staff have been recruited. This is so that staff absences or shortages can be quickly filled and people using the service have their needs met by adequate numbers of staff at all times. Our judgement The provider is compliant with this outcome because people who use the service can be sure that assistance would be forthcoming in an emergency and that appropriate fire safety practices are followed. Page 12 of 14

13 What is a review of compliance? By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. When making our judgements about whether services are meeting essential standards, we decide whether we need to take further regulatory action. This might include discussions with the provider about how they could improve. We only use this approach where issues can be resolved quickly, easily and where there is no immediate risk of serious harm to people. Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actions or compliance actions, or take enforcement action: Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying with essential standards, but we are concerned that they will not be able to maintain this, we ask them to send us a report describing the improvements they will make to enable them to do so. Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people. Page 13 of 14

14 Information for the reader Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public / Copyright (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Quality Commission Website Telephone address Postal address enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Page 14 of 14