The Care Quality Commission
  • Mental Health
  • Independent mental health service

Farmfield

Overall: Requires improvement read more about inspection ratings

Farmfield Drive, Charlwood, Horley, Surrey, RH6 0BN (01293) 787500

Provided and run by:
Elysium Healthcare No.2 Limited

All Inspections

21 June 2023 and 22 June 2023

During an inspection looking at part of the service

Farmfield Hospital provides Forensic medium secure, low secure and acute inpatient services for adult male patients. It has 80 beds over 7 wards.

Forensic services:

  • Rusper is a medium secure ward with 10 beds focusing on admission, assessment and treatment.

  • Hookwood is a medium secure ward with 10 beds focusing on admission, assessment and treatment.

  • Capel is a medium secure ward with 10 beds focusing on admission, assessment and treatment.

  • Newdigate 1 is a low secure ward with 11 beds focusing on admission, assessment and treatment.

  • Newdigate 2 is a low secure ward with 10 beds focusing on admission, assessment and treatment

The acute wards for working age adults consist of two wards:

  • Brockham is a 14 bedded admission ward.

  • Faygate is a 15 bedded admission ward.

Our rating of this location ​stayed the same​. We rated it as ​requires improvement​ because:

  • We inspected 2 domains which meant for those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

  • Staff had not always taken action when they identified items that needed replacing in the emergency bag.

  • Staff had not always completed the Drugs Likely for Misuse register.

However:

  • Staff had received the training they needed to care for the patients admitted to the hospital.

  • Staff received information including a risk assessment of all patients before they were admitted to the hospital and staff completed a risk assessment within 24 hours of a patient being admitted.

  • The provider was actively identifying restrictive practice and taking action to remove unnecessary restrictions that had been placed on patients.

  • Staff understood how to safeguard patients and took action when someone was at risk of abuse.

  • The provider had an effective governance system in place that identified any issues and managers shared learning with the whole team.

11-12 May 2021

During a routine inspection

Farmfield provides medium secure and low secure service for adult male patients. The provider opened a male acute ward Faygate in July 2020 and another Brockham in January 2021. It now has 80 beds spread over seven wards.

Our rating of this location overall stayed the same. We rated it as requires improvement because:

  • The acute wards were overly restrictive for patients; there were lots of rules that patients had to follow that were not individualised to each patient. There was a lack of robust rationale as to why these rules had to apply to everyone.
  • Patients on the acute wards told us that they were unhappy about not having keys to their bedrooms
  • The quality of the risk assessments was variable across the two acute wards and did not always include all identified risks, nor were they always updated following an incident.
  • The quality of care plans was variable across the acute wards and not all patients we spoke with felt involved in their planning their care. Some care plans we reviewed were generic and were not tailored to each individual patient.
  • The environment and facilities in the seclusion rooms on the acute wards did not meet the expected standard set out in the Mental Health Act code of practice. Neither seclusion room had clear two-way communication as the intercom did not adequately work.
  • Two of the secure wards had two separate locking systems for the ward anti barricade doors, these are doors that open both ways in an emergency. Staff were not able to quickly access and understand which keys fit which locks.
  • The forensic wards did not meet the therapeutic needs of the patients in accordance with National Institute for Health and Care Excellence (NICE) guidance, as there was a lack of therapeutic interventions and activities in the evenings and at weekends

However:

  • The wards had enough nurses and doctors. Staff assessed and managed risk well. The ward environments were safe and clean. They managed medicines safely and followed good practice with respect to safeguarding.
  • The service had put policies, procedure and additional cleaning in place to keep patients safe from Covid-19.
  • There was evidence of patients' physical health being monitored and the service employed a nurse who focussed on patients’ physical health and there were plans to employ another physical health care nurse.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Most 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.
  • The occupational therapy team had worked hard to provide an adequate level of service in the hospital through a difficult and challenging lockdown period. Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

22-24 January 2018

During a routine inspection

We rated Farmfield as requires improvement because:

  • There was insufficient clarity in the guidance for staff to safely manage the physical healthcare needs of patients with insulin dependent diabetes.
  • There was a variance in the ligature risks in the patient bedrooms on the low secure wards. This meant that some patients with similar risks of using ligatures could be accommodated in a less safe bedroom.
  • The hot water boilers in the kitchens of all the wards were unsafe for patients to use.
  • The water temperature in the showers on the low secure wards was extremely hot as the temperature regulator was not working. Patients had no way of regulating the temperature themselves and therefore were at risk of scalding themselves.
  • Staff raised concerns about the relationship between ward staff and the senior team at the hospital. Their concerns included not feeling that their views were considered by the senior team and also concerns about new employment contracts and how new policies were being implemented by the hospital management.
  • There were significant vacancies for occupational therapy. This meant that the range of structured activity offered to patients had reduced. 

However:

  • The five wards were bright and clean and had been well-maintained.
  • Patient records showed that they had received good assessments and had holistic care plans and up to date risk assessments.
  • Incidents, complaints and safeguarding issues were effectively recorded and investigated.
  • All staff had completed mandatory training and were supported by their line managers and had received an annual appraisal.
  • Patients said that staff were caring and considerate and that they were confident in raising any concern. There were forums for patients to raise issues and suggestions about the running of the hospital.
  • There were good systems in place providing ward managers with up to date information on how their ward was performing.
  • The senior team met in a monthly governance meeting to review and make decisions on risk, quality and staffing issues.

16th -18th August 2016

During a routine inspection

Overall Summary

The five questions we ask about our core services and what we found

We rated Farmfield as good because:

  • The wards were staffed with experienced and caring nurses. The hospital had its own bank of staff to cover most vacancies or used agency nurses that worked regularly at the hospital.
  • The ward managers had the ability and the authority to adjust the number of staff according to patient need.
  • The care records were comprehensive, updated, and contained live assessments of risk which were evaluated using a red, amber, green rating.
  • Medicines management and administration were good throughout the hospital.
  • Initiatives to reduce episodes of violence and aggression were practiced on the wards.
  • Care plans encompassed all areas of patient need. They were well written, informative and demonstrated that patients had been included in planning their own care and patients confirmed this.
  • All staff received regular training for their roles. The uptake of training was good amongst all disciplines. The impact of this training was evident in the care practices on the wards and in multidisciplinary meetings.
  • Wards operated a ‘buddy’ system whereby patients that were familiar with the ward assisted in supporting new patients.
  • Patients were invited to their ward rounds. There were no discussions about the patient either before or after their participation.
  • There was a progressive and clear recovery-oriented pathway for patients to follow from medium secure through to low secure and back to community settings.
  • Patients were able to make verbal and written complaints, they reported that the process was easy to follow and generally led to a quick resolution. Verbal complaint logs were held on each ward. Learning from complaint investigations was cascaded to staff through these logs.
  • The ward manager position was a key leadership role within the hospital with many delegated responsibilities. They were empowered to make decisions and received leadership training.
  • There were good systems in place to ensure that hospital procedures, policies and processes were followed. This assisted in keeping patients and staff safe and continuously improved the quality of care and treatment.

However:

  • Many of the patients appeared to be overweight. Although weight was monitored, healthy eating was not encouraged and 10% of patients had developed type 2 diabetes.
  • Patients on some of the wards had reduced access to the secure garden space.
  • There was a high level of vacancies within the occupational therapy team which reduced the availability of activities.

21-23 July 2015

During a routine inspection

We rated Farmfield as requires improvement because:

 

·        Risks in the environment were not always managed appropriately in relation to ligatures and the use of outside space, which could put patients at risk.

 

·        Infection control checks were only carried out annually.

 

·        The staffing of the wards was not always increased in response to managing potential risks.

 

·        Section 17 leave entitlement was not being managed appropriately on the wards in accordance with the Code of Practice: Mental Health Act 1983. (Section 17 of the Mental Health Act covers the circumstances in which patients detained for treatment may leave the hospital.)

 

·        The majority of staff had a limited understanding of the Mental Capacity Act 2005 (MCA), and this was confirmed in the records relating to the use of the MCA. (The Mental Capacity Act deals with patients’ capacity to take decisions and how decisions made on their behalf must be in their best interests.)

 

·        Patients were not treated with respect and dignity at all times by all staff, and were not always involved in planning their care and treatment. On Capel and Newdigate 1 wards, there were no doors to the en-suite bathrooms in patient bedrooms.

 

·        Patients did not have an individualised timetable of meaningful activities that met their interests and recovery goals. The activity provision did not meet commissioning for quality and innovation payment targets of 25 hours of activities offered per week to each patient.

 

·        Patients did not feel listened to when they made a complaint.  Verbal complaints were not acknowledged as complaints and were not recorded or investigated so patients did not receive a response. The provider did not act proactively in response to all patient feedback so this could not be used to make improvements to the service.

 

·        Morale was low among the majority of staff we spoke with and staff did not feel recognised or involved in improvements needed for the service.

 

  However:  

·        Medicines were managed well, and emergency resuscitation equipment was checked regularly.

 

·        Staff completed risk assessments and developed management plans to minimise risks to patients and staff. The risk assessment of patients was monitored and planned using appropriate tools to make it robust.

 

·        There were clear safeguarding processes. 

 

·        Clinical staff assessed patients’ needs on their admission to the hospital that were developed into care plans.

 

·        The physical health needs of patients were supported through regular checks and monitoring.

 

·        Staff had an understanding of the patients and supporting their individual needs.  Staff were aware of the diverse needs of patients and made attempts to meet individual needs. The patients generally liked the food provided and cultural needs were catered for.

 

·        There were local governance processes that helped identify where the service needed to improve. 

 

·        Staff felt supported at a local level by their peers and ward managers, though not by senior managers.  

 

·        Wards had targets for physical health, care planning and risk assessment. Performance was audited.

 

·        Monitoring of incidents of harm or risk of harm and safeguarding incidents was used to make improvements to the service.

   

 

    

 

   

 

 

 

           

 

 

 

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25 September 2013

During a routine inspection

We observed positive interaction between staff and people who used services on the day of our inspection. Staff responded to people's requests for support and appeared respectful and offered clear explanations to questions.

People were not always enabled to make or participate in making decisions relating to their care or treatment.

We spoke to five people who used the service. Some people told us that the occupational activities really helped them. One person we spoke with told us 'Going to the gym really helps me manage my anger when I am cross'. Another person told us 'We chose the new colours for the occupational bit and painted it ourselves. That was good to do'.

We saw that staff had access to the contact details for the local safeguarding team. We also saw that the service had quarterly safeguarding meetings that included attendance by their local safeguarding officer.

On the day of our inspection Farmfield was clean, tidy and in a good state of repair. The design and layout ensured that people who used the service could move around easily and there was adequate space for participating in activities, eating and socialising or finding a quiet space.

Staff we spoke with told us that they did not feel that there was always a good skill mix of staff on duty each day or that there were enough staff for them to cover all their duties. One person we spoke with told us 'There were only 3 of us on the ward the other day; I didn't feel safe'.

We saw that the provider completed yearly surveys for people who used the services/their representatives. We saw that the results had been collated, analysed and reviewed and that action had been taken based on the feedback.

At our last inspection on 21st of February 2013 we found that people were not protected from the risks of unsafe or inappropriate care and treatment as accurate records were not always kept. At this inspection we found an improvement in the quality of the records maintained. However, some information was still not recorded accurately.

21 February 2013

During an inspection looking at part of the service

We found that there were sufficient numbers of suitably trained staff available to meet the needs of patients. One patient we spoke to told us that the staff were "excellent" and that "there are always enough staff on shift so I do not need to wait for anything".

Staff told us that there were sufficient levels of staff available most of the time and that bank and agency could be used when there was an identified shortage.

We saw that care records were available but that information within the care note system were not available in a format which was accessible in a prompt manner due to staff not knowing how to locate the documents; this was attributed to an upgrade of the electronic carenotes system which staff were still "getting to grips with". The manager has provided the Care Quality Commission with assurances that additional training would be made available to staff and we will monitor this to ensure that records can be accessed by those staff who require access to records promptly.

27 September 2012

During a routine inspection

We spoke to four patients about their views of the care and treatment they received, where we were unable to speak to patients we relied on our observations on the day to form our judgements.

We saw that there were many examples of positive interactions between patients and staff and noted that patients were relaxed and at ease.

We saw several examples of staff treating patients with dignity and respect by knocking on doors and speaking appropriately. Patients told us that the staff were “Good” and that they felt able to speak to them about how they felt.

Patients also told us they liked the food that was provided and that it was “Good”. One patient told us that the food was “Okay” and another said it was “Fine”.

We found that patients sometimes were not able to do things like go out on leave as there were not always enough staff available to escort or assist them. One patient told us it was “Frustrating” when this happened and we saw examples of this during our inspection.

Patients told us they knew their rights and told us that they felt safe, they told us that if they had a problem or concern they knew who to speak to about it. One patient told us that the hospital was “Better than the last place I was in.”

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.