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

Battersea Bridge House

Overall: Requires improvement read more about inspection ratings

1 Randal Close, Battersea, London, SW11 3TG (020) 7924 7991

Provided and run by:
Battersea Bridge House Limited

All Inspections

26 and 31 October 2022

During a routine inspection

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.

09-11 November 2021

During a routine inspection

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.

Our rating of this location went down. We rated it as requires improvement because:

  • The service did not have robust governance systems to ensure the quality and safety of the service. Some actions from the previous inspection remained outstanding and it was not clear who had oversight of these or why actions had not taken place. For example, some blind spots remained on the wards.
  • Wards were not always safe. There were potential ligature anchor points on all wards. Fifty percent of the staff we spoke to were not aware of any ligature points and the mitigations for these. Staff did not complete and regularly update thorough risk assessments of all ward areas. We did not see evidence of individual risk assessments for patients to access their phones and the internet unsupervised.
  • The service did not always have enough staff. Staffing was calculated for the hospital as a whole, as opposed to the individual wards. There were occasions when a ward was staffed by a single support worker. The service had a single consultant providing medical cover at all times. The service did not have a psychologist in post. Patients were therefore unable to access psychological therapy and specialist forensic risk assessments were not being reviewed or updated.
  • Mandatory training compliance fell below the service’s 80% target in eleven courses. For example, basic life support, mental health act awareness and medication management
  • The service did not always comply with corporate policy in relation to infection prevention and control as some staff did not wear protective face coverings. Not all patients on the ward had personal emergency evacuation plans readily available in case of a fire emergency.
  • Staff did not always follow systems and processes to prescribe and administer medicines safely. For example, escalating fridge temperatures that fell outside of parameters and monitoring medicines expiration dates. Systems to ensure the safety and efficacy of some clinical equipment were not in place. Records to show that the clinic room and equipment were regularly cleaned were not in place.
  • Not all staff understood how to safeguard patients from abuse. Staff had training on how to recognise and report abuse, however they did not always know how to apply it.
  • Clinical information was not always accessible, and the service did not maintain high quality clinical records. There was a mix of paper and electronic records. There were multiple places that physical health checks could be recorded, making them difficult to track. Staff did not always document risks to patients and themselves.
  • The service did not develop individual care plans. They were not personalised, holistic or recovery oriented and did not include patient views.
  • The hospitals audit programme had not been completed. Where audits had identified issues, it was not clear what action was being taken to address these. Complaint investigations did not record details of the investigation or outcome.
  • Local leaders had not considered how recent high staff turnover and the appointment of significant new members to the multidisciplinary team should be supported to encourage the development and embedding of the ‘right’ culture across the hospital

However:

  • Most staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They supported patients to understand and manage their care, treatment or condition.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.
  • 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. The ward staff participated in the provider’s restrictive interventions reduction programme. Wards had a good track record on safety.
  • Staff planned and managed discharge well. As a result, discharge was rarely delayed for other than clinical reasons.
  • Each patient had their own bedroom with an en-suite bathroom and could keep their personal 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.

To Be Confirmed

During a routine inspection

We rated Battersea Bridge House as good because:

  • The service supported patients’ recovery by providing treatments recommended by national guidance. This included prescribing appropriate medicines, providing a comprehensive range of occupational therapy and providing psychological therapies. Patients had individual therapy sessions with a psychologist as needed and others attended group therapies.
  • Patients said that staff treated them well. Patients described staff as nice, helpful and respectful. Patients were involved in decisions about their care and treatment. Patients met with staff every day in a relaxed and friendly environment to plan activities and groups for the day.
  • Staff managed risks presented by patients well. All patients received a full risk assessment on admission, including a full risk assessment. Staff reviewed patients’ risks every day and adjusted the level of restriction placed on each patient to reflect the risks they presented. The service had introduced a programme to reduce restrictive practices. This had resulted in the use of seclusion falling from 24 incidents in 2016 to eight incidents in 2018.
  • The service provided care and treatment to patients in a clean and pleasant environment. All patients had their own bedroom with ensuite facilities. There were appropriate facilities available for patients’ care and treatment.
  • Patients had good access to physical healthcare. A GP visited the hospital at least once every two weeks. Staff referred patients to specialists when necessary. Staff completed regular health checks of patients receiving high doses of medication.
  • The service employed experienced staff who were well supported through supervision, annual appraisals and team meetings. The service addressed poor performance appropriately.
  • The service supported patients’ discharge well. Staff planned patients’ discharges over a number of months. Patients were granted leave to visit and stay at their new accommodation before the full discharge took place. Only one of the current patients had experienced delays to their discharge for non-clinical reasons.
  • The service supported patients to engage in many activities in the local community to support their recovery. This included access to a choir, sports clubs and community cafes. Patients’ feedback about these activities was very positive.
  • The service had a structured system of governance that ensured staff and managers reviewed learning from incidents, safeguarding matters and complaints. The service had addressed concerns raised at our last inspection about ensuring there was oversight of patients’ physical health, including the physical health of patients receiving high doses of medicines, and that the service notified the CQC of incidents. Staff felt the hospital director provided good leadership.

However,

  • Some nurses and support workers said they did not feel listened to by the management team or involved in decisions about patients’ care. Some members of staff said morale was low.
  • There were some environmental risks such as poor sight lines on the wards and low risk potential ligature points that the service needed to address.
  • The service had a high vacancy rate for registered nurses but all shifts were covered and the provider was recruiting to these posts.

7, 8, 22 September 2017

During an inspection looking at part of the service

This was an unannounced, focused inspection, where we looked at whether the provider had made the improvements we identified as requiring improvement at our previous inspection in April 2017. We did not rate the service as a result of this inspection. We found the provider had made improvements since the previous inspection and had complied with the warning notice which we served on them in May 2017:

  • Safe staffing levels were maintained and staff received regular supervision. Systems were in place to ensure that all incidents within the hospital were reported and that learning from these took place. Staff were now able to access emergency medicines and equipment without delay. Senior leaders were more visible and visited the hospital regularly. Patients were supported to receive treatment for general physical health issues. Systems to monitor side effects and monitor physical health for patients prescribed clozapine were now in place. Medicines were safely stored at the correct temperature.
  • A programme to reduce the number of potential ligature anchor points was ongoing and appropriate measures to manage and mitigate risks associated with these were in place. Faults with the secure entry door to the hospital had been addressed. Complaints records were readily accessible and included information on the investigation and outcome of the complaint. The progress of safeguarding alerts was monitored. Mental Health Act documentation was available and was maintained in good order. Appropriate arrangements were in place to support patients with their finances and to be able to access these when needed. A review of systems was underway to ensure that changes in risk resulting from incidents were reflected in the patient risk assessment. Improvements to how discussions and decisions made in multidisciplinary meetings were recorded were also underway.
  • Patients received regular one to one sessions with their named nurse. Care plans were recovery focused and included plans for discharge. Where patients were nursed in seclusion their care and treatment was regularly reviewed and these reviews were appropriately documented. Staff use of viewing panels in patient bedroom doors now promoted patients’ privacy and dignity. Patients were involved in developing their care plans and staff knew how to access interpreting services. For patients with learning difficulties staff took time to work through their care plans with them ensuring they understood and agreed with them. Patients had their rights regularly explained to them and an easy read rights leaflet was available. Opportunities for patients to develop skills and take up vocational training had been developed.

However, further improvements were needed:

  • The provider’s systems to monitor the safety and performance of the service were not consistent and in some instances not embedded. Further work was needed to strengthen systems to ensure that additional physical health checks immediately following the administration of high dose antipsychotics or olanzapine, were robust, consistent and embedded. We escalated these concerns to the provider during the inspection to ensure the health and wellbeing of the patients. The provider immediately addressed these concerns by carrying out physical health checks on all patients and training the staff on the safe administration of these medications.
  • Some incidents that should have been notified to the Care Quality Commission had not been. Systems to learn from incidents at other hospitals managed by the provider were not in place.

19-21 April 2017

During a routine inspection

We rated this service as requires improvement because:

  • The hospital and the staff were experiencing a period of change with a new interim hospital director having been recently appointed. The hospital director was aware that a number of improvements were required in the service, though some work had not begun or been embedded at the time of inspection.
  • At this current inspection, we identified that the provider had not addressed all the concerns that led to a rating of requires improvement for safe, following the previous inspection.
  • Following our previous inspection, we issued a number of recommendations for the service to consider. At this current inspection, we identified that some improvements had not been made to ensure the recommendations were being met.
  • During this inspection, we found that the management of medicines was not safe. Physical health checks and observations were not being routinely completed for patients on high dose antipsychotic medicines. Medicines were not always stored safely and staff did not assess and monitor patients for physical health side effects from clozapine treatment. In May 2017 we served the provider with a warning notice relating to these concerns.
  • Staff did not follow up on patients’ identified physical health concerns following assessments and physical health observations.
  • Staffing levels were not always sufficient to meet the needs of patients. The provider had shifts that did not meet minimum staffing requirements and a qualified nurse was not always present in the communal areas. Some patients we spoke with said that they did not meet with their named nurse regularly.
  • Staff did not undertake and document appropriate reviews of patients who were subject to the restrictions of seclusion.
  • Staff did not always consider the specific communication needs of patients who had borderline learning disabilities or communication difficulties and include these in care planning.
  • Emergency medicines were not easily accessible to staff on Browning and Hardy wards.
  • Patients were unable to close observation panels on bedroom doors.
  • Staff were not receiving regular clinical supervision.
  • There were ineffective systems to robustly govern and monitor the performance and safety of the provider. The provider’s complaints log had no evidence of investigations or outcomes of complaints. The system for recording incidents was not effective.

However:

  • At the current inspection, the provider had improved in some areas where recommendations were given at our previous inspection. This included record keeping, regular access to the self-catering kitchen, appropriate physical health observations after rapid tranquilisation and ensuring the hospital director had sufficient authority to carry out their role.
  • Staff were caring and respectful to patients and overall patient feedback was positive.
  • Patients had good access to psychological treatment including groups and individual sessions.
  • Patients had access to a large number of varied activities throughout the week to support them to develop skills to promote their future independence.
  • Staff were happy with their work life balance and felt morale had improved.

7 & 8 July 2015

During a routine inspection

We gave an overall rating to Battersea Bridge House of good because:

  • The hospital maintained safe staffing levels. Medical cover was available at all times. Pre-employment checks were conducted prior to staff commencing their employment. Staff completed mandatory training and received regular managerial supervision. Care plans were up to date, holistic and recovery-orientated. Care and treatment records were maintained. An appropriate range of disciplines made up the multidisciplinary team and regular team meetings were held. A timetable of clinical audits had been developed and was used to monitor and improve services.
  • Staff completed risk assessments and these were updated regularly. Staff reported safeguarding concerns appropriately. There were effective working relationships with outside stakeholders (for example, GPs, care co-ordinators and commissioners). We observed responsive, respectful interactions between staff and patients. There were effective governance systems to monitor key performance areas. Staff morale was good and there was strong local leadership.

However:

  • A number of ligature points had been identified and while local measures were used to manage and mitigate risks, work to address the risks was required. No date had been fixed for the work. (Ligature points are places to which a patient intent on self-harm might tie something to strangle themselves.) A number of environmental concerns had been placed on the hospital’s risk register, including frequent water leaks, bacteria in the hospital’s water system and problems with door locks.
  • Staff had not recorded some regular observations of patients in seclusion. While arrangements for ordering, storage and disposal of medicines were safe, an audit in December 2014 identified 27 errors. Some patients who had received rapid tranquilisation had not had their physical health checked appropriately.
  • The hospital had developed a complaints policy and procedure but information on how to make a complaint was not displayed. Not all information relating to an individual complaint was readily accessible.
  • The majority of staff did not feel there was a clear connection between the provider’s corporate managers and the hospital. There were no structures at a corporate level for staff to share learning from incidents across hospitals.

22 October 2013

During a routine inspection

During the visit some people using the service said they were generally treated with dignity and respect by staff whilst others felt otherwise. Comments included "Staff are fine", "They don't help you write to people or find out more about where you can move to", "It is good to live here but some of the staff are not all that" and "Quite hospitable and feel I can speak to staff".

Some people were positive about the treatment they received, felt well supported, were involved in their treatment and felt they were making progress. "I'm making progress". Others saw their treatment and the support they received more negatively. "I'm not happy here and would like to transfer back to the Maudsley".

People said they were satisfied with the accommodation and happy with the cleanliness of wards and their rooms. "My room is fine, no problem".

There were suitable activities provided, although some people said they would rather not be there at all.

They were aware of the complaints procedure and how to use it.

We saw that people using the service were treated with dignity and respect by staff during our visit.

The sample of assessment information and support plans we looked at were comprehensive and up to date with the required information on file. The admissions criteria was followed and risk assessments were in place and regularly updated.

We walked around the building and found the wards and other areas were clean, fit for stated purpose, well maintained and appropriate to the type of support and treatment provided.

Staff told us they were well supported by the management team and we saw that appropriate background checks were carried out on them including Disclosure and Barring Service (DBS) checks. "My manager and staff have been very helpful going through my preceptorship".

Staff said and records demonstrated that they had good access to training and development.

There was a robust complaints procedure that people had access to and was followed.

8 February 2013

During a routine inspection

During our inspection the people using the service said they were generally treated with dignity and respect by staff although some more than others. Comments included "I don't have a problem with any staff", "Staff facilitate progress", "Some staff make flippant comments that aren't appropriate" and "If you want anything done ask the nursing team". They were positive about the treatment received, confirmed they were fully involved and contributed to their care plans. We also saw this in the care plans we looked at. They were up to date with all the required information on file. There was also a thorough admissions criteria that was followed and risk assessments in place. We toured the building tour found the wards and other areas were well maintained and appropriate to the type of support and treatment provided. Staff were well supported by the management team and appropriate background checks were carried out on them including Criminal Records Bureau (CRB) checks. Staff also had good access to training and development. There were comprehensive audit based quality assurance systems in place that were regularly updated and contained identifiable performance indicators and trigger levels. People using the service that we spoke to were happy with the cleanliness of wards and their rooms. They service did not comment on the hospital assessment, monitoring and recording systems or the support staff received.

4 February and 19 April 2011

During a routine inspection

When we visited there were twelve people using the service and we spoke to a number of these.

People were generally happy being at the service, and felt that they get appropriate support from the staff.

People told us that the environment is supportive to helping them meet their needs.

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.