Rosebank House

We rated Rosebank House as good because:

• Staff and patients reported feeling safe on the unit. Staff carried out regular environmental and ligature risk assessments. The unit met the department of health guidance on same sex accommodation. Staff never used restraint and patients and staff reported a calm and stable atmosphere.

• We reviewed five care records and found risk assessments present and up to date in all five. Staff updated risk management plans and discussed risk at multidisciplinary team meetings. Staff encouraged positive risk taking.

• Staff completed care plans with patients and encouraged patients to be involved in decisions about their care and treatment. Staff used recognised rating scales to measure progress. All patients had a discharge plan and a target discharge date.

• Staff monitored physical health care effectively. Many patients had physical health concerns and all had clear care plans to manage their physical health needs.

• Staff kept prescription and medicine charts in good order. Staff checked for gaps or discrepancies in medicine charts at each handover and carried our regular medicine audits.

• Staff were aware of patients’ individual needs. The new occupational therapy team intended to source community resources for older people and we saw evidence of staff meeting the needs of one patient with particular communication needs.

• Staff and patients contributed to multidisciplinary team meetings.The full range of mental health disciplines provided input into the unit. The provider was working with staff and patients to encourage continued recovery based practice suitable for a rehabilitation environment.

• Staff received appropriate training and support. Compliance with mandatory training was high and staff accessed regular supervision, appraisals and attended team meetings.

• Staff interacted with patients in a caring and respectful manner at all times. Patients attended daily planning meetings and regular community meetings and staff encouraged them to contribute.

• Patients knew how to raise a complaint and staff handled these appropriately.

• Staff reported they knew senior managers in the organisation and felt supported by the new provider. All staff spoke positively about the team ethos and spirit and enjoyed working at the unit. Staff knew how to raise concerns and felt safe to do so.

However:

• Staff sickness was high at 9 per cent and three out of five qualified nursing posts were vacant. The provider used regular agency staff where possible to provide continuity and offered incentives to potential new applicants.

• At the time of the inspection, we were not clear on the processes for reporting safeguarding concerns. Following the inspection the registered manager confirmed the process had been agreed with the responsible local authority.

• There was no record on the incident forms or in meeting minutes of what lessons were learned and no evidence of actions taken as a result of incidents. However, staff reported incidents appropriately and the registered manager informed us learning from incidents was shared at team meetings.

• The unit risk register did not reflect current risks and did not feed into the wider risk register for the organisation. Senior managers were addressing this issue.

• The consultant assessed capacity to consent to admission and treatment on a regular basis. However we found no evidence that staff assessed capacity or recorded best interest decisions in relation to any other decisions.

We rated Rosebank House as requires improvement because:

• The nurse in charge carried a master key for the bedrooms, however other staff did not have master keys. We were concerned that not all staff could access patient bedrooms in an emergency. Communal bathrooms had nurse call buttons on the walls but not an emergency pull cord in reach of the bath.

• The provider offered 22 mandatory training courses. In five of these courses, staff compliance was well below 75%. Mental Capacity Act training was 35%, diabetes awareness was 35% and epilepsy awareness was 41%.

• We found capacity assessments in patients’ notes differed to capacity assessments on patient medicine charts. We also found two cases where informal patients did not have capacity to consent to admission and treatment. The lack of robust recording procedures around capacity meant patients may be treated without valid consent.

• There were low levels of specialist staffing. The psychology post was vacant and the occupational therapist was part time. The provider did not offer specialist rehabilitation training for hospital staff. Supervision rates were very low and staff did not receive regular appraisals.

• The provider did not have clear policies on admission, eligibility and exclusion criteria for the service. Staff could not state where the service lay in the rehabilitation care pathway, which could lead to a lack of focus and direction.

• Staff reported there was a lack of consistency and direction around recovery based practice. During our inspection there were no structured activities planned at the hospital and some patients had little to occupy them.

However:

• Staff carried out regular ligature and environmental assessments that mitigated any risks identified. Staff completed regular health, safety and infection control checks.

• Staff regularly reviewed risk, and risk assessments for each patient were present, thorough and up to date. We saw detailed risk management plans for specific risks with individual patients.

• Staff reported incidents appropriately and the provider implemented processes to learn from incidents.

• Care plans were present and in date for all patients. Care plans were person centred and holistic. Staff reviewed and updated care plans on a regular basis. Staff monitored physical health care thoroughly and effectively.

• We witnessed caring and respectful interactions between staff and patients during the inspection. We spoke with four patients who all reported staff were supportive, kind and helpful. All four patients were offered a copy of their care plan.

• Staff encouraged patient involvement and feedback through community meetings, patient satisfaction questionnaires and comment boxes. The hospital provided regular access to advocacy. Patients knew how to make a complaint and staff dealt with complaints appropriately.

• Governance arrangements were improving. Incidents, staff vacancies, complaints and training levels were identified, discussed at local and organisational level and action plans implemented. This ensured standards and quality of the service improved.

• All staff reported being happy in their jobs and feeling supported by management.