28 - 30 January 2020
During a routine inspection
Eldertree Lodge is an independent mental health 41 bedded hospital. It provides specialist inpatient service for adults aged 18 years and over in rehabilitation units specifically for patients with a learning disability or autism.
Our rating of this service went down. We rated it as requires improvement because:
- The provider had not made sure that the environment was suitable for all patients it provided care to. Although it was providing care to adults with a learning disability and autism the wards were not ‘autism friendly’ in line with national recognised best practice. For example, managers had not considered the conflicting sensory needs of patients living on the same ward. Ward environments were not tailored to the sensory needs of individual patients.
- The provider had not ensured that staff received specialist training in caring for people with autism, including training in specialist communication skills.
- The provider did not ensure that the systems used to access information was well organised, staff were struggling to find essential information to support safe and effective care delivery, whether it was on electronic or within paper notes.
- Staff did not always follow best practice when storing and dispensing medication. Staff on Maple Ward did not routinely record the date of opening of new creams and bottles. They therefore could not be assureds the medications were still effective when given to patients. The providers own audits of medicines management had not identified the error we found on inspection.
- Staff supervision was not managed well; managers did not have robust systems to ensure they knew whether staff received regular supervision.
However:
- The service generally provided safe care. The ward environments were safe. The wards had enough nurses and doctors. Staff assessed and managed risk well, followed good practice with respect to safeguarding and minimised the use of restrictive practices.
- Staff implemented good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging. The service had identified a local theme in self-harm through swallowing batteries and provided an individualised response to patient risk.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. The multidisciplinary team involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided.
- 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. They actively involved patients and families and carers in care decisions.
- Patients led discussions of their experience of care in a programme of ‘noise, voice, choice’ meetings. Carers, families and external agencies were extremely positive about the service and believed the service always managed challenging behaviour well.
- Staff planned and managed discharge well and liaised with services that would provide aftercare. The provider had developed some local accommodation options that the hospital clinical team could continue to provide some support to patients as they settled in and got to know a new staff group. Staff helped patients with advocacy, cultural and spiritual support.