Report Leigh House, Specialised Services Winchester Thursday 23 rd February 2012 Overall Impression Leigh house appeared to have a calm and relaxed atmosphere with a non-clinical feel, a nice environment which was well-maintained. All staff were very friendly, open and accommodating. Staff were knowledgeable about the service and showed awareness of CQC. Staff interacted well and were courteous and responsive with young people. Young people said this hospital is better than most. Education facilities are good and are adapted to needs of the young people. The over sixteen s younger people stated they would have liked more education input. Until recently educational input was not required past the age of sixteen however the service has fought hard to secure from Hampshire County Council (HCC) what input they have currently and will continue to support HCC further developing this. Type of Service Page 1 of 9
Leigh House is a 7 day residential psychiatric unit with 20 inpatient beds. Age range: 12-18. Leigh House admits adolescents with severe psychiatric illness, e.g. psychotic disorder, eating disorder or severe depression and provides specialist assessment, care, support and treatment for young people. What We Did We reviewed information relating to incidents, complaints, clinical audits, risks, compliments and litigation prior to visiting the site. We undertook an unannounced inspection on Thursday 23 rd February 2012 which focussed on Outcome 4 Care and Welfare, Outcome 9 Managing Medicines and Outcome 14 Supporting Workers. We spoke to staff, service users, made observations and reviewed documentation. What the Outcomes Say Outcome 4: Care and Welfare People who use services experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. Outcome 9: Managing Medicines People who use services will have their medicines at the times they need them, and in a safe way. Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf. Outcome 14: Supporting workers People who use services are safe and their health and welfare needs are met by competent staff. Overall Impression Leigh house appeared to have a calm and relaxed atmosphere with a non-clinical feel, a nice environment which was well-maintained. All staff were very friendly, open and accommodating. Staff were knowledgeable about the service and showed awareness of CQC. Staff interacted well and were courteous and responsive with young people. Young people said this hospital is better than most. Education facilities are good and are adapted to needs of the young people. The over sixteen s younger people stated they would have liked more education input. Until recently educational input was not required past the age of sixteen however the service has fought hard to secure from Hampshire County Council (HCC) what input they have currently and will continue to support HCC further developing this. What We Found Page 2 of 9
Outcome 4: Care and Welfare People who use services experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. Staff The team spoke to six members of staff; the Modern Matron, the Clinical Ward Manager, two nurses, one health care assistant and the Ward Clerk and the following points were identified: Staff are aware of CQC and how it relates to their working. Staff have collected evidence on patient experience objectives for 2012 and these include the CQC outcomes. Staff had a good knowledge of assessment process and developing of treatment plans. Staff interacted well with good communication skills with service users and their relatives in relation to assessments and treatment plans. Staff also liaise with other disciplines and teams for the service users. There were contingency plans in place for the escalation of risks and symptoms. Risks are reviewed on a daily basis for the young service users deemed to be at risk. Daily multi-disciplinary handovers take place where risks and changes are highlighted and are well communicated within the MDT group. Changes to treatment plans are always discussed with the young service user and their families are also informed. Families are also informed about incidents or issues relating to the service user. Staff gave an example; service users were issued with non-camera mobile phones where required and a blanket ban had been enforced for a short period to defuse a problem. Letters were sent to families to inform them. Staff said the young service users have access to computers under supervision, all young service users have their own rooms, mobile phones and diversity is accommodated accordingly. There is a system in place to cascade Patient safety and medication alerts and staff are made aware of any alerts. CPA review meetings take place after the first six weeks where everyone involved in the young person s care is invited along to the meeting, including the community team. Some staff have additional training in eating disorders, whilst others with a special interest in the Snoezelen room equipment cascade their expertise to other staff. Leigh House is a non-smoking site if the young service users are admitted and smoke then they would be provided with patches or appropriate alternative and a smoking cessation programme would be followed. Page 3 of 9
The young service users are generally fully involved in the decision making for their treatment; however they may also be detained under the Mental Health Act or their parents if the young person is under 16 years could agree consent until such times the young service users can make informed decisions. Some young service users are admitted with mental ill health may also have drug and alcohol issues however this is rare, urine tests would be completed after leave. Service Users The inspection team spoke with three service users receiving care and the following points were identified: Service users reported that they are involved in their treatment planning and agree their plan of care. Service users are able to visit the service with a relative as part of the initial assessment or at weekends prior to admission. Voices 4 Choices meetings are held regularly for the young service users. The young service users said they liked this as it was independent Leigh house also has a flat available where their families can stay when a young person is unable to go home for leave. Young service users and their families said it was good to have the flat availability and was appreciated ; as some families had to travel from the Channel Islands. Young service users have controlled and supervised access to the internet. Education facilities are good and are adapted to the needs of the young service user. Young service users have a weekly timetable of activities which includes organised education. School on site is managed by Hampshire County Council staff who work closely with the nursing staff at Leigh house. Documentation The team reviewed a variety of documentation; RIO, policies, staff meeting minutes, service user notes, secondary files, medication charts, self-harm packs, young person packs, CQC information and leaflets; and the following points were identified: Care plans were up to date and reviewed regularly. Risk assessments and Consent to information sharing forms were signed, in place and evident in the young service users notes. Feeding guidelines for young people with Anorexia Nervosa were in place and weight charts were up to date. The service Integrated Governance meeting had a well-structured agenda. Page 4 of 9
Staff information was well documented and staff know where to access books. Research information is available for staff. Local policies were available and up to date. The service hold an informal concerns file where the Modern Matron notes actions from informal concerns. Voices 4 choices meetings are held for young service users and run by an outside agency, minutes are kept. Staff training records for medical device training appeared to be up to date and held within the MDA folder Observation The team observed a handover and the treatment of three young service users and the following points were identified: The inspection team observed non validated records within RIO produced by the administration staff on behalf of clinicians. Staff are aware of this problem and looking at ways to remedy it. Staff who are lone working are provided with either a walkie-talkie, personal alarms or a mobile phone when out escorting a young person. Staff photographs were on display which showed their names and professions. A board showing which health care worker was allocated to each young service user was updated at the beginning of each shift by young service users. Searches of young service user s belongings and a person scan are conducted when appropriate. Local and Trust policies are followed in relation to searches. An independent advocacy service is available to any young person. The accommodation for young service users are of single sex bedrooms, downstairs rooms have en-suite bathrooms and upstairs rooms have access to shared single sex bathrooms. There are age appropriate communal lounges with TV/DVD/Games, Kitchen/dining room. The Snoezelen room is a relaxed area fitted with lights and aromatherapy diffuser under supervised use. Leigh House also has a games room for the young service users. Outcome 9: Managing Medicines Page 5 of 9
People who use services will have their medicines at the times they need them, and in a safe way. Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf. Staff The team spoke to six members of staff; the Modern Matron, the Clinical Ward Manager, two nurses, one health care assistant and the Ward Clerk and the following points were identified: Medication policies and how staff would follow these; staff knew how to raise concerns and report incidents. Staff provide young service users with age appropriate leaflets A staff member returning from maternity leave has been facilitated to do training on medicines management to enable them to undertake their full nursing role Service Users There was no information from young service users relating to this outcome. Documentation The team reviewed a variety of documentation; RIO, policies, staff meeting minutes, young service user notes, secondary files, medication charts, self-harm packs, young person packs, CQC information and leaflets; and the following points were identified: Daily and weekly checks of equipment are up to date. Medication charts were up to date and appropriately signed. Storage of medication was as per policy Staff were able to advise on the destruction of meds. Physical charts for young service users were up to date in clinics. All staff were up to date with medicines management training. Observation The team made observations throughout the inspection and the following points were identified: Medications to take out and patients own dispensing system was used and the policy was followed. The dispensary and drugs cupboard are locked and located in a private corridor, so young service users can come in one at time to get medicines and have their privacy and dignity respected. There is a treatment room for the taking of bloods. Resuscitation equipment, sharps bins, rapid tranquilisation/restraint care pathway, temperature, blood pressure and respiration charts were also kept in the room Page 6 of 9
Drugs were disposed of in the correct manner and the policy followed, medical waste poster on cupboard in locked drugs cupboard. Rapid tranquilisation information was displayed in the dispensary. Sharps information was displayed on the walls in the clinic. Outcome 14: Supporting workers Page 7 of 9
People who use services are safe and their health and welfare needs are met by competent staff. Staff The team spoke to six members of staff; the Modern Matron, the Clinical Ward Manager, two nurses, one health care assistant and the Ward Clerk and the following points were identified: Staff said they were well supported by the management team. Staff returning to work from extended sick leave said they felt supported and the policy is used correctly for recording and helping staff with their health needs. An external contracted facilitator comes to the unit every two weeks to chair supervision sessions with staff. All staff reported they have regular supervision and was up to date. All staff reported that their annual appraisals were up to date. Staff said Resuscitation training was up to date and that the equipment had been audited the week before. Staff were aware how to raise any concerns and were supported if there was an incident. Information Governance (IG) training is work in progress. There are monthly Integrated Governance meetings to discuss the units needs and staff training and opportunities for additional training Service Users There was no information from the service users relating to this outcome. Documentation The team reviewed training records and the following points were identified: There appeared to be some staff out of date with patient handling but the Modern Matron was reviewing this. Observation The team made observations throughout the day and the following points were identified: Staff morale appeared to remain high even though the team had lost ten members of nursing staff recently. Five new starters are due to commence soon and three post still remain vacant. Staff had a lot of expertise gained through in-house training and role modelling. Page 8 of 9
Recommendations Outcome 4: Care and Welfare We recommend that all RiO entries are validated in particular those initiated by the administration staff. Outcome 9: Management of Medicines There were no recommendations relating to this outcome. Outcome 14: Supporting workers We recommend that all clinical staff are up to date and attend patient handling training as per Trusts statutory and mandatory training guidelines and requirements. Best Practice The following points have been highlighted: Staff have a good awareness of the CQC and how it relates to their working. Staff are collating patient experience objectives for 2012. Staff interacted well with good communication skills with service users and their relatives and liaise with other disciplines and teams. Leigh house has a flat available for use by families. Young service users and their families said it was good to have the flat availability and was appreciated ; as some families had to travel from the Channel Islands. Education facilities are good and are adapted to the needs of the young service user. The accommodation at Leigh house is of single sex bedrooms, downstairs rooms have en-suite bathrooms and upstairs rooms have access to shared single sex bathrooms. There are age related communal lounges with TV/DVD/Games, Kitchen/dining room. The Snoezelen room is fitted with lights and an aromatherapy diffuser under supervised use. and there is also a games room for young service users. Report Date: 29.02.2012 Page 9 of 9