16 and 17 May 2023
During an inspection looking at part of the service
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.
The Care Quality Commission (CQC) conducted an unannounced inspection of Cedar House on the 16 and 17 May 2023. The inspection was to check if the improvements required following the inspection in November 2022 and detailed in an action plan submitted by the provider in June 2023 had been made.
Our overall rating of this service stayed the same. However, our rating of well-led improved and the service has therefore exited from special measures.
We have identified breaches in relation to risk management and the quality and assurance systems in place at this inspection. We have issued the provider with a warning notice because processes to enable the systematic review and management of ligature risks were not robust. Audits used to oversee the safety of the service were completed but governance around how ligature risks were systematically reviewed and actions carried out were not evident or documented effectively. Furthermore, systems and processes in place were not robust enough to ensure oversight of the quality and safety of the service, experience of service users and accurate record keeping.
We rated it as requires improvement because:
- Local governance systems in place to effectively assess, monitor and improve the quality and safety of the service required further embedding. Ligature audits were not always reviewed thoroughly to help manage the risk to patients, staff did not always record clinic room temperatures routinely to ensure medicines were stored safely, care and treatment records following incidents were not always accurate or complete, and the review of people’s restrictions for accessing kitchen areas were not always thorough. These had not been identified by the provider’s internal governance processes.
- Staff did not always record or share key information to keep people safe when handing over their care to others.
- A systematic process for sharing lessons learned with staff at ward level was not embedded. Records of discussions about actions implemented because of lessons learnt were not well recorded in team meeting minutes and these were not regularly reviewed with all staff.
- Staff were not always assessing people’s risk safely prior to section 17 leave. This meant that there was a risk of people being allowed to leave the hospital without the proper risk assessments conducted in a timely manner prior to leave.
- Staff were not consistently completing all their mandatory and statutory training. Only 40% of eligible staff had completed training in the safe administration of medicines. Managers did not ensure that all staff had completed the required competencies and mandatory training prior to administering medicines independently.
- Some areas of the environment remained tired and did not fully meet the needs of people using the service. Lighting had previously been identified as not suitable for autistic people. However, measures to reduce or remove the risks within a timescale that reflected the impact on people using the service were not effective.
- Staff were not always aware of the principles of ‘right support, right care, right culture’. Most staff below ward manager level were unable to tell us about the new clinical model of care and how this underpinned their work with people using the service.
However:
- People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs.
- People were protected from abuse and staff followed good practice with respect to safeguarding.
- People made choices and took part in activities which were part of their planned care and support. The staffing provision for psychological therapies had improved and this aligned with the new clinical model of care. A multidisciplinary team worked well together to provide the planned care.
- 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 ensured care plans were personalised, recovery focussed and holistic. People were involved in planning their care.
- 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 they went home.
- The provider engaged with other organisations to improve the care offered at the hospital. Staff used national outcome measures to identify the effectiveness of their service.
- The provider offered professional development and training opportunities.
- 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.