19 October 2022 and 20 October 2022
During an inspection looking at part of the service
Our rating of this location improved. We rated it as requires improvement.
The Care Quality Commission conducted an unannounced inspection of Uplands Independent Hospital on 19 and 20 October 2022 to check that the improvements detailed in the warning notice served following our inspection January 2022 had been made. In January 2022 we rated the hospital inadequate and placed it in special measures.
On 28 and 29 June 2022 we undertook a focussed inspection to check whether improvements had been made. We found that the provider had made some improvements but needed more time for improvements to be fully implemented. The provider gave us assurance that they would continue to improve. We decided to give the provider more time to make the required improvements but to monitor it closely. The hospital remained in special measures and continued to be rated inadequate.
During this inspection we saw that the provider had maintained the improvements we found in June 2022 and had continued to make progress with the areas that required improvement outlined in their action plan. They had started work to improve the environment, installed a new fire alarm system, ensured staff undertook mandatory training and commenced recruitment for a range of clinicians so they could offer a full multidisciplinary team input to patient care. Whilst the provider had developed a comprehensive rehabilitation and recovery care model this had not yet been fully implemented or embedded within the services practice. Staff had involved patients in developing the new model of care and we also saw that staff were more engaged with patients; offering more one to one engagement time. Senior managers were visible across the hospital and staff felt they were approachable, listened to them and acted on their concerns. However, the provider was clear that they still had actions to complete and that they needed to continue embedding the improvements they had already made.
Our rating of this location improved. We rated it as requires improvement because:
At this inspection we found:
- The provider had not yet fully addressed all of the improvements to the environment identified in their action plan. For example, some ligature anchor points remained although these could have been removed and these were not all included in the ligature risk assessment. Not all patients had access to a nurse call system in their bedrooms so would be unable to call for help if they needed to.
- The provider had reduced the number of registered nurses on duty, since our last inspection, as the number of patients admitted to the hospital had reduced. However, the staffing ladder used to identify the number of registered nurses required on the ward focussed more on the number of patients rather than the care they needed.
- Care plans were not as person centred or recovery focused as they could have been. For example, they did not detail how patients could gain the skills needed to live in the community. Staff did not always document how patients had been involved, in care planning, recorded best interest decisions for patients that lacked capacity or if they had understood changes to their treatment.
- Staff told us that they sometimes had to cancel escorted community leave because of staffing numbers.
- We found that one medication record did not have a completed section 62(1) urgent treatment form attached to it. A section 62(1) urgent treatment form is needed to authorise treatment which has not been agreed by the patient when a patient does not or cannot consent and treatment has been agreed by a second opinion appointed doctor.
- The provider did not actively seek feedback from families and carers about the service.
- The female lounge was a long distance from the main areas of the hospital so not easy for female patients to access.
- The provider was in the early stages of implementing a new governance process across all of its services. Managers at Uplands were still introducing this structure so not all governance process were working effectively.
- The provider had identified a new rehabilitation and recovery focused model of care, but this had not been fully implemented at the time of the inspection.
However:
- The ward remained clean and there were maintenance plans in place to improve the environment.
- The hospital had reduced the number of agency staff it used. All staff received an induction before working at the hospital. The service held regular multidisciplinary team (MDT) meetings and was actively recruiting to ensure they had a complete MDT available to the patients.
- The care plans in place met and identified patients’ physical and mental health needs. Staff supported patients to access physical health care. Staff used rating scales to identify and meet patients’ needs. All patients’ records we reviewed had a positive behaviour support plan in place, which staff understood, and a discharge plan.
- Staff ensured that the clinic room was fully equipped and clean and the provider had introduced an electronic prescription system to reduce errors.
- Interactions we witnessed between patients and staff were caring and respectful, patients told us they felt safe in the hospital and knew how to complain. Staff completed a daily risk assessment for each patient and reported incidents appropriately.
- The provider had opened a female lounge and was preparing a room to be used as a gym for the patients.
- There was a new hospital director in post and the provider had agreed a long hand over period with the interim hospital director to ensure consistency.
As a result of the improvements, we will remove the hospital from special measures.