Mental Welfare Commission for Scotland Report on unannounced visit to: Polmuir Road Rehabilitation Unit, 15 Polmuir Road, Aberdeen AB11 7RS Date of visit: 21 February 2017
Where we visited Polmuir Road is a mixed-sex community rehabilitation service, with facilities for 10 service users in 5 x 2 bedroom flats. On the day of the visit, there were only eight occupied beds as a result of the refurbishment work taking place. We last visited this service on 10 June 2015 and made the following recommendations: the ward manager should ensure that there is an audited named nurse system in place; care plans should be individualised; and worn furniture should be replaced. On the day of this visit we wanted to follow up on our previous recommendations. Who we met with We met with and/or reviewed the care and treatment of six patients. We spoke with the nurse in charge and other nursing staff. Commission visitors Douglas Seath, Nursing Officer David Barclay, Nursing Officer What people told us and what we found Care, treatment, support and participation We met with four people in the unit, and reviewed their files and the file of one other person. The service users were able to tell us about their experience of care and treatment in the unit. Individuals were positive about the care and support staff were providing and about the contacts they had with staff, and our observations during the day of the visit were that interactions between staff and people in the unit were positive and encouraging. Risk assessments and care plans were of a good standard, with appropriate individual care plans prepared depending on the needs of the individual person, and with the content of plans being very detailed and person-centred. It was not clear, however, how the named nurse system was working. Although there is a named nurse for each patient, individuals did not meet them on a regular basis nor was there a record of meetings to evaluate care. Specific documentation is used to record the multidisciplinary team (MDT) reviews, and these reviews were also clear and detailed. MDT meetings are held weekly but MDT Review meetings, which patients and carers attend, are less frequent. Carers 1
are also invited. Individuals also sign their care plans and reviews where they have discussed and agreed with the contents. There appears to be good psychology input into the unit with individual sessions provided on a regular basis for individuals. There is also good occupational therapy input, providing assessments and programmes of activities focussed on particular daily living skills. Annual physical health checks are carried out and documented in files. Recommendation 1: The ward manager should ensure there is an audited system of review by named nurses and meetings with individuals are clearly documented in patient files. Use of mental health and incapacity legislation Mental Health (Care & Treatment) (Scotland) Act 2003 documentation was wellorganised in files, and where people were subject to compulsory measures, medication being administered was authorised appropriately by consent to treatment (T2) or certificate authorising treatment (T3) forms. Rights and restrictions There were no restrictive practices highlighted on the day of the visit. External doors to the unit are locked and patients are requested to be in by midnight. This has not caused any difficulties and patients have their own keys for ease of exit and entry. Activity and occupation There is a strong ethos of rehabilitation, supporting individuals to move from the hospital ward environment into the community unit and into independent living. We found good evidence of nursing staff and occupational therapists providing a range of inputs, including skills development and facilitating activities both on and off the units. Each patient is encouraged to budget and cook for themselves, according to their skills level, with assistance provided if necessary. Those patients we spoke to who engaged in these activities were satisfied with the support offered and the progress they were making towards more independent living. Activities are many and varied with programmes designed around rehabilitation. Individuals have work placements, attend college and participate in voluntary placements. There are also social outings both escorted and unescorted to give patients opportunities to develop skills in this area and to expand their social networks prior to discharge. 2
The physical environment We were pleased to see that since our last visit, furnishings had been replaced with new items and the flats are being refurbished to bring them up to an acceptable standard. The communal areas are generally in good condition with new furnishings and were clean and tidy on the day of the visit. Kitchens appear well provided and were also clean and tidy. Patients can smoke cigarettes outside and are requested to move away from the building to prevent accidental ingress of smoke. To the rear of the building is an open aspect looking over the local bowling green. Summary of recommendations 1. The ward manager should ensure there is an audited system of review by named nurses and meetings with individuals are clearly documented in patient files. Service response to recommendations The Commission requires a response to this recommendation within three months of the date of this report. A copy of this report will be sent for information to Healthcare Improvement Scotland Alison Thomson Executive Director (nursing) 3
About the Mental Welfare Commission and our local visits The Commission s key role is to protect and promote the human rights of people with mental illness, learning disabilities, dementia and related conditions. The Commission visits people in a variety of settings. The MWC is part of the UK National Preventive Mechanism, which ensures the UK fulfils its obligations under UN treaties to monitor places where people are detained, prevent ill-treatment, and ensure detention is consistent with international standards When we visit: We find out whether individual care, treatment and support is in line with the law and good practice. We challenge service providers to deliver best practice in mental health, dementia and learning disability care. We follow up on individual cases where we have concerns, and we may investigate further. We provide information, advice and guidance to people we meet with. Where we visit a group of people in a hospital, care home or prison service; we call this a local visit. The visit can be announced or unannounced. In addition to meeting with people who use the service we speak to staff and visitors. Before we visit, we look at information that is publicly available about the service from a variety of sources including Care Inspectorate reports, Healthcare Improvement Scotland inspection reports and Her Majesty s Inspectorate of Prisons inspection reports. We also look at information we have received from other sources, including telephone calls to the Commission, reports of incidents to the Commission, information from callers to our telephone advice line and other sources. Our local visits are not inspections: our report details our findings from the day we visited. Although there are often particular things we want to talk about and look at when we visit, our main source of information on the visit day is from the people who use the service, their carers, staff, our review of the care records and our impressions about the physical environment. When we make recommendations, we expect a response to them within three months (unless we feel the recommendations require an earlier response). 4
We may choose to return to the service on an announced or unannounced basis. How often we do this will depend on our findings, the response to any recommendations from the visit and other information we receive after the visit. Further information and frequently asked questions about our local visits can be found on our website. Contact details: The Mental Welfare Commission for Scotland Thistle House 91 Haymarket Terrace Edinburgh EH12 5HE telephone: 0131 313 8777 e-mail: enquiries@mwcscot.org.uk website: www.mwcscot.org.uk 5