Battersea Bridge House

Updated 16 January 2023

We undertook this unannounced comprehensive inspection of Battersea Bridge House to see if they had made improvements following the concerns found in our inspection in November 2021.

Battersea Bridge House is a low secure independent hospital in South West London. It provides care and treatment to men aged 18 years and over with severe mental illness and additional complex behaviour. Battersea Bridge House is part of the Inmind Healthcare Group, an independent provider of mental health and social care services.

The service has 22 beds and it provides services across three wards:

• Browning ward has 10 beds

• Blake ward has six beds

• Hardy ward has six beds

At the time of our inspection all 22 beds were occupied. All patients receiving care and treatment were detained under the Mental Health Act.

The service is registered to provide:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury.

The hospital director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service.

Battersea Bridge House registered with the CQC in December 2010. There have been eight inspections. We last inspected Battersea Bridge House in November 2021 when we rated the service as ‘requires improvement’ overall, with a rating of inadequate for safe, requires improvement for effective, caring and well-led, and good for responsive.

What people who use the service say

We spoke with nine patients across the three wards on the first day of the inspection. Patients were mostly positive about their experience on the wards. Two patients described the ward environment as calm and one patient described it being like a ‘family’. Most patients said the staff were caring, although one patient said agency staff were rude and another patent said staff can be disrespectful.

All patents said they had authorised leave from the hospital. Some patients said there were a variety of activities that they enjoyed, whilst some patients said there were a lack of activities, particularly on the weekends. Patients said that sometimes there were not enough staff to facilitate activities. All patients had one to one meetings with their nurses, and the multidisciplinary team.

Most patients said they felt safe on the ward, whilst two patients said they did not. Two patients said that they were frustrated with the delays in their discharge from the hospital.

Updated 16 January 2023

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

• We rated the service as requires improvement for safe and well-led. This was a follow-up inspection to the comprehensive inspection in November 2021. Whilst the service had made improvements in some areas, there was still more work to do to ensure they delivered consistent high quality care.
• The service did not have a local procedure in place to safely monitor drugs liable for misuse (DLM), which was against the provider’s medicines management policy. There were discrepancies (of 3 tablets) between the number of DLM recorded as stock and the actual number of physical medicines on all three wards.
• The service did not always have robust governance systems to ensure the quality and safety of the service. There had been a recent lapse in some quality assurance processes and some actions from the previous inspection remained outstanding or had taken a long time to action. We found a number of issues that were still outstanding from the issues identified in the last inspection in November 2021. The service was unable to provide assurance that the blood glucose testing kits were suitable for use, not all staff were trained and assessed as competent to complete medicines tasks, and risk assessments were not always up to date and did not outline how staff would mitigate identified risks.
• The staff turnover rate was high at 33%, which impacted consistency of care delivered to patients. This service had risk-rated staff turnover as red on their site improvement plan, but it lacked robust actions to encourage staff retention.
• The service had not been able to consistently offer a range of nationally recommended psychological therapies due to difficulties in recruiting a forensic psychologist since our last inspection. At the time of the inspection, a forensic psychologist had recently started in post.
• Records did not contain all necessary information. Electronic records were comprehensive and updated following changes in patients’ risk or need. However, staff did not always update paper records to reflect these changes.
• The service had been slow to ensure all staff were compliant with fire evacuation training. The service had identified the training need in 2021, but compliance remained low at 51%.
• There were delays in discharges of care. Some patients told us they found these delays frustrating. As a result, some patients were ready to move on but unable to. The hospital had a full bed occupancy and were unable to admit any new patients.
• There were a number of new appointments to the multidisciplinary team at the time of the inspection, therefore, the staff team still needed support to develop an effective working culture.

However:

• Our ratings for safe, effective and caring improved since our last inspection in November 2021. The service had made a number of improvements . For example, ligature risk assessments were up-to-date, personal emergency evacuation plans were in place, night-time staffing had increased, and out of hours medical cover had improved. A quality improvement manager had been employed to support the team to make improvements in quality and safety.
• Most patients told us they felt safe. The ward environments were safe and clean.
• Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint and seclusion only after attempts at de-escalation had failed.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients.
• Each patient had their own bedroom with an en-suite bathroom and could keep their belongings safe. There were quiet areas for privacy.
• The food was of a good quality and patients could make hot drinks and snacks at any time.

Updated 16 January 2023