24 September 2020
During an inspection looking at part of the service
The Huntercombe Hospital – Roehampton provides psychiatric intensive care (PICU) services for both male and female patients and an acute ward for male patients. However, at the time of the inspection the female PICU was closed.
Our overall rating of the service improved from requires improvement to good.
This was a focused inspection where we looked at the key questions, are services safe, effective and well led. At our previous inspection in November 2019 we had proposed to the registration of the service. The provider had appealed against this proposed cancellation and provided a detailed plan of how they would improve the service. At this inspection we found these improvements had been made.
A condition to restrict the number of patients to 28 patients at the hospital remains in place.
Our rating for the safe key question improved from inadequate to good. Our rating for the well led key question improved from requires improvement to good. Our rating for effective stayed the same and remains good. Our overall rating of this service changed to good as a result of this inspection.
We rated The Huntercombe Hospital - Roehampton as good because:
- The service had improved its approach to staffing the service. During our last inspection in November 2019, we found that up to 75% of support workers were employed by agencies. These staff did not receive supervision or appraisal. The hospital did not have systems for assessing the skills, experience and competency of these staff. Since that inspection, the hospital had stopped using agency staff and had recruited permanent staff to provide safe care and treatment. Staff said this had led to significant improvements in the culture of the hospital and the quality of care provided to patients.
- Safety had improved. During the last inspection we found that there were frequent disturbances on the wards. Patients said they found the hospital noisy and scary. Since then, the hospital had introduced clear criteria for admission. The service accepted patients who had never been in a PICU providing they met the criteria for admission and that any presenting risks could be managed safely within a PICU setting. Staff reported that the wards were safer.
- The service had introduced a restrictive interventions reduction programme. Staff said there was a greater focus on understanding patients concerns, de-escalation and using restraint in a way that was safe. Staff were committed to only using restrictive interventions as a last resort. Staff received effective training on this and were skilled and experienced. Enhanced observations were used for the least amount of time and reviewed daily by the clinical team.
- The service model and environment had been re-designed since the last inspection. The number of PICU beds had been reduced and the service had introduced a 10 bed acute ward. This was to create a smaller recovery focussed environment and provide a pathway for patients to be cared for in a less restrictive environment.
- When serious incidents occurred, managers carried out thorough investigations and shared the learning from these investigations with the staff. When members of staff raised whistleblowing concerns with the CQC, the manager investigated these concerns promptly, provided thorough responses and acknowledged problems when appropriate.
- All staff spoke positively said they felt supported by the registered manager.
- Staff said that managers communicated well. They said they had opportunities to raise concerns and that managers listened and took action in response.
- The hospital managed matters relating to the COVID-19 pandemic effectively. The hospital had introduced appropriate arrangements for enhanced infection prevention and control. At the time of our inspection, no patients or staff at the hospital had acquired COVID-19.
- 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 felt respected, supported and valued. Since the last inspection there were improvements to the culture of the hospital. Staff were provided with opportunities for development and career progression. They could raise any concerns without fear. Staff reported they were positive and proud to work for the provider.
- Governance processes operated effectively, and performance and risk were managed well.