Archived: Cedar House

Updated 23 November 2020

Cedar House is a specialist hospital managed by The Huntercombe Group, providing assessment and treatment in a low secure environment. The service has six wards and capacity for 39 patients. The hospital provides low secure inpatient services for people with a learning disability or autism who have offending or challenging behaviour and complex mental health needs.

The wards include:

• Folkestone ward is an eight-bed ward for male patients.
• Folkestone enhanced low secure (ELS) ward is a six-bed ward for male patients. This area of the ward provided a service to patients who had particularly challenging behaviour.
• Maidstone ward is a six-bed ward for female patients.
• Tonbridge ward is an eight-bed ward for male patients.
• Rochester ward had three male patients as well as single annexes for another three male patients.
• Poplar ward is a locked rehabilitation ward for five male patients. This ward was outside the secure perimeter fence.

Cedar House is registered to provide the following regulated activities;

• assessment or medical treatment for persons detained under the Mental Health Act 1983
• diagnostic and screening procedures
• treatment of disease, disorder or injury

Cedar house has been inspected three times in 2020. Prior to the recent inspection, we carried out a comprehensive inspection of Cedar House in February 2020, following which the hospital was placed in special measures and rated inadequate. We then carried out a focused inspection on 21 July 2020 when we served a warning notice.

Updated 23 November 2020

On the basis of this inspection, the Chief Inspector of Hospitals has recommended that the provider be placed into special measures.

We rated Cedar House inadequate because:

• The hospital was not always able to adequately meet the complex needs of some of the patients. These patients had behaviours that were very challenging for staff to manage but the measures in place to manage their needs and risks (such as long-term segregation and use of physical restraint) had impacted negatively on their quality of life.

• There were high levels of restraint at the hospital. Staff who were unfamiliar with patients did not always follow de-escalation techniques before restraint was used.

• All wards we visited looked tired and showed signs of damage which could present a safety risk for patients. Four of the six wards were visibly unclean. We raised this at the time of the inspection and undertook a further visit five days later and found that short term repairs to the environment had been made. All the wards at the service still looked bare.

• The hospital had insufficient systems and processes in place to ensure all environmental risks were identified and mitigated. The ligature risk assessment did not identify how some of the identified risks should be mitigated.

• Whilst there were always enough staff on each shift, there was an increasing vacancy rate and increasing use of agency staff, many of whom were often unfamiliar with the patients. Therefore, some permanent staff members felt there were not enough staff who knew patients well enough to provide good quality care and meet patient needs at all times.

• We found blanket restrictions on all the secure wards. Button batteries were not allowed on the wards. Patients had not had individual risk assessments to decide whether this restriction was necessary.

• A small number of patients had been receiving care and treatment at the hospital for too long. Senior managers were working with commissioners to identify alternative placements and support the transfer of patients.

• Senior managers were not visible in the service and nursing staff felt they did not understand the daily challenges on the wards. Some nursing staff felt that the psychology team were rarely present on the wards. Staff from different disciplines appeared to work in isolation and there was a disconnect between the nursing team and the wide multi-disciplinary team. Whilst ward managers were felt to be supportive, they were not based on the ward which affected their availability to lead and oversee care. Feedback from staff was that they did not always have enough time, training or support to provide person centred care for people.

• Support staff had a limited understanding of why some patients could have section 17 leave and others could not.

However:

• Staff had training on how to recognise and report abuse, and they knew how to apply it. Staff recognised incidents and reported them appropriately. The senior management team had effective working relationships with stakeholders to review patient related incidents.

• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medicines on each patient’s physical health. They knew about and worked towards achieving the aims of STOMP (stopping over-medication of people with a learning disability, autism or both).

• Staff provided a range of treatment and care for patients based on national guidance and best practice; this included access to psychological therapies. Patients had access to occupational therapies. Staff supported patients with their physical health and encouraged them to live healthier lives.

• 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 actively sought patient feedback on the quality of care provided and enabled them to contribute to decisions about how the hospital operated. They ensured that patients had easy access to independent advocates. Staff informed and involved families and carers appropriately.

• Staff supported patients to access a range of therapeutic activities, opportunities for education and developing skills for employment within the hospital and local community.