05 January 2022
During an inspection looking at part of the service
John Munroe Hospital – Rudyard is part of the John Munroe Group and is an independent mental health hospital that provides care, treatment and rehabilitation for up to 57 adults, aged 18 or over, with long-term mental health needs services. Edith Shaw Hospital is also part of the John Munroe Group and is located nearby.
The service was most recently inspected in August 2021. We carried out this inspection to follow up on concerns raised at a focussed inspection in January 2021 where the service was rated as inadequate and placed in special measures. We also served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within four days that described how they would address our concerns. The provider’s response did not provide enough assurance that they had acted to address immediate concerns.
Due to the serious nature of the concerns we found during the August 2021 inspection, we used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and imposed additional conditions on the provider’s registration. This included a condition to restrict the provider from admitting any new patients to John Munroe Hospital – Rudyard without the prior written agreement of the Care Quality Commission. This inspection rated John Munroe Hospital – Rudyard as inadequate and placed it into special measures.
On 1 December 2021 John Munroe Group announced to CQC they planned to close the John Munroe - Rudyard site on 28 February 2022 due to the cost of changes and maintenance required to the building and staffing pressures due to the service’s rural location. The commissioners were working with people to find suitable alternative placements.
This inspection commenced on 5 January 2022 and was an unannounced, focussed inspection to see what improvements the provider had made. Our inspection focussed on the concerns we raised to the provider following our previous inspection.
We found improvements in some areas of the service during this inspection, but some serious concerns remained. As a result, the additional conditions on the provider’s registration remained in place. This included a condition to restrict the provider from admitting any new patients to John Munroe Hospital – Rudyard without the prior written agreement of the Care Quality Commission. This inspection rated John Munroe Hospital – Rudyard as inadequate and kept it in special measures.
Our rating of this location stayed the same. We rated it as inadequate because:
- The service was due to close in eight weeks and five out of seven patient records we spoke to did not know their discharge destination.
- Discharge was not adequately planned, co-ordinated and communicated to meet the safe and timely discharge of patients.
- The environment was not always fit for purpose. The building did not meet fire and electrical testing requirements.
- We found maintenance concerns had not always been raised and addressed.
- Fridge temperatures had not been recorded regularly and patient fridges consisted of food that had been opened and not labelled correctly showing when it was opened and when it should be consumed by.
- Not all staff had up to date mandatory training. Training compliance levels were lower than the providers target of 80% for safeguarding training children training, health and safety training, diabetes awareness and manual handling training.
- Staff were not appropriately supervised or supported in line with the provider’s policy.
- Patients did not always have a care plan in place that was detailed and personalised for all areas of care.
- Governance processes in place were not effective and performance and risk were not managed well.
- Staff did not feel respected and valued by senior people in the organisation.
However:
- Staff used approved restraint techniques and patients were not exposed to unnecessary risks of harm and abuse.
- Senior management now reviewed all incident on CCTV to ensure all incident report are an accurate reflection of incidents and all lessons learnt are identified and shared.
- The provider had a process in place to ensure all safeguarding incidents are identified, recorded and reported.
- Ligature anchor points and blind spots were identified, risk assessed and had clear mitigation in place.
- The environment was safe and free from sharp objects and fixtures were secured or removed.
- Waste was now being disposed of appropriately. There were no clinical waste bags and general waste bags stored outside wards or within patient areas.
- Staff followed infection control measures in line with the provider’s policy and visitors were asked to wear clinical face masks as soon as they entered the service.
- Emergency grab bags were secured effectively and had completed checklists in place.
- Staff were aware of the rapid tranquilisation policy
- Medication was stored at the recommended temperature and guidance was in place for what actions staff should take if medication fridge temperatures were out of range.
This service remains in special measures. Services placed in special measures would usually be inspected again within six months. As the provider had decided to close the service CQC will not be going out to reinspect the service.