Gateway Recovery Centre

Updated 5 April 2024

Wards for people with a learning disability or autistic people.

Cedar ward is a ward for autistic men who have mental health needs. The ward focused on people’s rehabilitation. All people admitted to the ward were detained under the Mental Health Act.

There was a registered manager of the service who was the hospital director.

There was a controlled drugs accountable officer who was the lead nurse.

The service is registered to provide the following regulated activities:

Assessment or medical treatment for persons detained under the Mental Health Act 1983

Treatment of disease, disorder or injury

The service was last inspected in June 2018 as part of the rehabilitation service, it was rated as good and there were no breaches of regulations.

At this inspection we have inspected the ward under the wards for people with a learning disability or autistic people methodology.

What people who use the service say

We spoke with 8 people and 4 carers. People said the service was clean and they felt safe on the ward. People told us that staff responded if there were incidents and there were staff available to support them.

People felt happy on the ward and said that they had the opportunity to do a variety of activities including walking, cooking, art and music.

Two people felt involved in their care and creating their plan.

People said the food had improved since there was a new chef. However, 2 people said there was still more improvement need with the food. One person told us that some staff are difficult to get along with.

Two people did not feel involved in their care, 2 people felt confused about the discharge plan, they felt they had achieved their actions but were still in hospital. Another person was disappointed with how long it took to find an appropriate placement to be discharged to. Another person would like staff to explain their medicines and treatment to them.

One person felt the housekeeping staff needed to ensure they protected their privacy and dignity and ensured it was appropriate for them to enter their room.

One person said due to staffing it can be difficult for staff to do activities with them.

One person said there was no access to a minister of religion at the hospital.

What carers say

Carers told us that the service was very welcoming to them, communicated with them and arranged for visits to take place, even where that was a considerable distance.

They were involved in their loved one’s care by contributing at the assessment and goal setting stage and regularly for reviews including Care Programme Approach reviews.

However, there was nowhere on site that they could get food and drink from.

Carers were not sure of the complaints process.

Carers told us that some staff do not understand how best to support their loved ones and they felt that agency staff may not have accessed all of the training that would help them.

Long stay/rehabilitation mental health wards for working-age adults.

The service provides long stay/rehabilitation mental health wards for working-age adults.

The service provides an assessment and rehabilitation pathway for women with complex mental health needs and personality disorders, as well as a specialist inpatient service for men with complex mental and physical health needs. There are four wards within this service:

Ash ward: specialist inpatient service for men with challenging behaviours, complex mental and physical health needs, and those with cognitive impairment.

Beech ward is a ten bed, safe and highly supportive environment for women with high risks of significant self-harm. Within Beech ward the focus is on reduction of acute risks of self-harm, aggression, and non-adherence to treatment by addressing core emotional and mental health problems.

Elm ward is a 12 bed, structured setting with routines and boundaries for patients who displayed significant risk but require slower stream rehabilitation due to complex difficulties.

Fir ward is a 12 bed, low dependency, rehabilitation ward with active therapy and interventions to facilitate recovery and community integration.

There was a registered manager of the service who was the hospital director.

There was a controlled drugs accountable officer who was the lead nurse.

The service is registered to provide the following regulated activities:

Assessment or medical treatment for persons detained under the Mental Health Act 1983

Treatment of disease, disorder or injury

The service was last inspected in June 2018 and it was rated as good and there were no breaches of regulations.

At our last inspection in June 2018 the service was rated as good overall and good in all five domains.

We identified a ‘should’ do action to improve the language in care plans, which included jargon or terminology that might be confusing to patients.

What people who use the service say

Patients told us they were cared for by caring staff who went beyond their regular roles to support patient care and treatment. Staff were described as helpful but could do with more training to support patients after they had psychology sessions, to help patients lessen their distress. The psychological therapies were described as life changing by patients. The variety of food was described as both good and not offering healthier choices. Patients said they wanted more opportunities to have ward-based cooking of their own meals and education including literacy, maths, and opportunities to gain employment. Patients did not like to be supported by male agency workers, who they had nothing in common with and who did not attempt to engage with or get to know patients. Patients told us they experienced levels of restriction and security, which was not in keeping with a model of rehabilitation and did not reflect an individual approach to their care. Patients told us they wanted their care records to be written in plain English and use non-medical words. Patients told us they needed more clarity around how the care pathway supported them to move to a less restrictive and acute environment, to one where they felt they had more autonomy over personal decision making and were ready for discharge.

Forensic inpatients or secure wards

Dove ward is a low secure forensic ward. The ward provides care and treatment to men over the age of 18 and offers a slow-stream, low secure service for individuals who have been in secure services for a long period and who may have offences which make it difficult for them to move to step down services.

Dove ward is located at the Gateway Recovery Centre which is a wider hospital site including acute adult mental health wards and a ward for individuals with a learning disability and/or autism.

The service is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder or injury.

The service has not been inspected before.

What people who use the service say

People who used the service were positive about the ward, staff and the care and treatment they were receiving. We spoke with 4 patients as part of our inspection. Patients described staff as kind, caring and considerate. They felt the service was helping them with their mental health and recovery.

Updated 5 April 2024

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

• Patient care and support was not always provided in environments which were well-maintained and allowed them access to space to meet their mental health, sensory, physical and recovery needs.

• Staff did not follow policies on infection control.

• In the autism and learning disability service staff did not lessen risks within communal areas where there was not a clear line of sight.
• The provider did not have sufficient, appropriately skilled staff to meet patient needs and keep them safe. Agency staff were not effectively inducted into the ward or show how best to support patients.
• Medicines administration was not completed at a safe time (during lunch) or in private, as medicines were administered in the dining room on one ward. Medicines policies were not followed, and medicines risk assessments were not completed. Staff had not always accurately recorded patient allergies on prescription charts. Out of date medication was not always disposed of in a timely manner.
• Governance processes did not meet the requirements for fit and proper recruitment of staff. Information prior to December 2023 had been sent for storage and archiving, including observation records, cleaning records, community meeting minutes and complaints, this meant the information was not easily accessible.
• When restrictive practices were used, there were inconsistent approaches from staff and unclear rationales in adhering to the policy. Patients where unclear how decisions were made to try and reduce the use of restrictive practices and improve their recovery. There were not always comprehensive reviews to try and reduce the use of these practices.
• Patient care, risk management, treatment, and support plans, did not always reflect patients own words and experiences and used medical language and not plain English. In the In the autism and learning disability service care records did not always reflect patient’s sensory, cognitive and functioning needs. There was not any accessible, easy to understand information for each patient setting out how best to support them.
• Staff supported patients through a model of care which was under review and needed additional benchmarking and refinement to provide clarity on the level of restriction and security being proportionate to the service being delivered.

However:

• Patients were protected from abuse and poor care.
• Patient risks were assessed regularly and managed safely. Patients were involved in managing their own risks whenever possible.
• Patients made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
• Patients received care, support and treatment that met their needs and aspirations. Care focused on patient quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• Patients were provided with care, support and treatment from the providers trained regular staff and specialists able to meet patient needs. These staff were not irregular agency staff.
• Managers usually made sure staff had relevant training, regular supervision, and appraisal except for agency staff. In the In the autism and learning disability service and low secure services managers made sure staff received training, supervision and appraisal.
• Patients and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983, and the Mental Capacity Act 2005.
• Patients were in hospital to receive active, goal-oriented treatment. Patients had clear plans in place to support them to return home, back to services they were admitted from, or move to alternate community living. Staff worked well with services that provided aftercare to ensure patients received the right care and support when they went home. As a result, discharge was rarely delayed for other than a clinical reason.
• Patients received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. Patients had their communication needs met and information was shared in a way that could be understood.
• In the low secure the ward environments were safe and clean. The ward had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• The service had programmes of audit and assurance in place. Managers had access to up-to-date information and performance data.

Updated 5 April 2024

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

SUMMARY

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

• People’s care and support was not provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.
• Staff did not follow policies on infection control and mitigating risks within communal areas where there is not a clear line of sight.
• The service did not have sufficient, appropriately skilled staff to meet people’s needs and keep them safe. Agency staff were not effectively inducted into the ward and how best to support people.
• When restrictive practices were used, there were not always comprehensive reviews to try and reduce the use of these practices.
• People’s care, treatment and support plans, did not always reflect their sensory, cognitive and functioning needs. There was not any accessible, easy to understand information for each person setting out how best to support them.
• Leadership was not always good, senior leaders were not visible on the wards.
• The service did not meet the requirements for fit and proper recruitment of staff.

However:

• People were protected from abuse and poor care.
• People’s risks were assessed regularly and managed safely. People were involved in managing their own risks whenever possible.
• People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
• People received care, support and treatment that met their needs and aspirations. Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• The service provided care, support and treatment from trained regular staff and specialists able to meet people’s needs. Managers ensured that staff had relevant training, regular supervision and appraisal.
• People and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.
• People were in hospital to receive active, goal-oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support when they went home.
• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.
• Staff supported people through recognised models of care and treatment for people with a learning disability or autistic people.

Updated 5 April 2024

We have not inspected this service previously. We rated it as requires improvement because:

• Staff did not follow all policies on infection prevention and control.
• Medicines were not always managed safely. Staff had not always accurately recorded patient allergies on prescription charts. Out of date medication was not always disposed of in a timely manner.
• Governance processes did not meet the requirements for fit and proper recruitment of staff.

However:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• 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.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service had programmes of audit and assurance in place. Managers had access to up-to-date information and performance data.

Updated 5 April 2024

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

• Patient care and support was not provided in an environment which was well-maintained and allowed them access to space to meet their mental health, sensory, physical and recovery needs.
• Staff did not follow policies on infection control.
• The provider did not have sufficient, appropriately skilled staff to meet patient needs and keep them safe. Agency staff were not effectively inducted into the ward or show how best to support patients.
• Medicines administration was not completed at a safe time (during lunch) or in private, as medicines were administered in the dining room on one ward. Medicines policies were not followed, and medicines risk assessments were not completed.
• When restrictive practices were used, there were inconsistent approaches from staff and unclear rationales in adhering to the policy. Patients where unclear how decisions were made to try and reduce the use of restrictive practices and improve their recovery.
• Patient care, risk management, treatment, and support plans, did not always reflect patients own words and experiences and used medical language and not plain English.
• Governance processes did not meet the requirements for fit and proper recruitment of staff.
• Staff supported patients through a model of care which was under review and needed additional benchmarking and refinement to provide clarity on the level of restriction and security being proportionate to the service being delivered.

However:

• Patients were protected from abuse and poor care.
• Patient risks were assessed regularly and managed safely. Patients were involved in managing their own risks whenever possible.

• Patients made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.

• Patients received care, support and treatment that met their needs and aspirations. Care focused on patient quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• Patients were provided with care, support and treatment from the providers trained regular staff and specialists able to meet patient needs. These staff were not irregular agency staff.
• Managers ensured staff had relevant training, regular supervision, and appraisal except for agency staff.
• Patients and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983, and the Mental Capacity Act 2005.
• Patients were in hospital to receive active, goal-oriented treatment. Patients had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provided aftercare to ensure patients received the right care and support when they went home.
• Patients received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. Patients had their communication needs met and information was shared in a way that could be understood.