Archived: Slade House

The Trust chose to stop admissions to both units following our inspection in September 2013. They were told by the Commission they could re-admit when they felt fully confident they had completed their compliance actions. They have not yet admitted anyone to either of these locations.

After the last patient on STATT moved out in December 2013, the Trust closed that unit. We were therefore only able to view care within John Sharich House on this inspection.

On our arrival, we were shown around JSH. We saw that there were five staff on duty for five patients. The staff told us that four of the five patients being cared for would be discharged soon and arrangements were being made for this. We were able to speak with some patients in John Sharich House, but one patient did not wish to speak with us. We asked them about the assessment, treatment, care and support they received. One person told us it was 'okay' and said they were happy being cared for there.

Another patient told us they were not happy to have had their baths stopped. We were surprised to hear that bathing was not allowed for anyone. We asked why this was. We were told this had been a response to a death in the unit last summer when a young man had died in the bath. We asked if this decision had been made with input from all relevant professionals and from the patients it concerned. We were told it had not.

Patients told us that their consent was sought before any care or treatment was commenced. However, it had not been sought regarding the decision on bathing and one patient was able to tell us they were 'upset' about this.

We spent time observing the daily work of the unit. Although we heard warm personal interactions between staff and patients, we noted little obvious therapeutic activity throughout the day. Staff stayed in the staff room for considerable lengths of time, working on administrative tasks. This surprised us, as this had been an area of rigorous discussion after the previous inspection.

We asked members of staff what the purpose of the unit was. We received a variety of answers from senior clinicians and other members of staff. We asked how treatment success or failure was measured. We were told there were no specific pathways, but that care was nevertheless tailored to the individual patient.

We discussed safeguarding training and knowledge. The staff told us they felt confident in this area.

We inspected the medicines policy and procedures and found that these were correct.

We looked at the quality monitoring checks that took place. These are used to enable senior staff to check the unit was functioning safely and well, and if it was providing good care and appropriate support. We saw that a family information group had recently started.

We examined records of people, of staff and of equipment. These were mostly satisfactory.

The outcomes inspected on this visit were all environmental. This was to check the cleanliness, safety and suitability of the building, and of the emergency equipment supplies.

We found that suitable improvements had been made to each of the outcomes, and they are now compliant with the required standard.

We were unable to speak with people on John Sharich House as they did not wish to do so. On the STATT unit, we spoke with three of five people there. We asked them about the assessment, treatment, care and support they received. One person told us they felt unsafe and uncared for, another told us they 'hated it' there. The third person said 'It is okay.'

We spent some time observing the interactions between people and staff. There was a marked difference between the two units. JSH staff interacted positively and therapeutically on many occasions. We did not see this on STATT. Whilst we were there, up to four staff mainly worked on administrative tasks within their office, with one member of staff out on the unit. Over the course of two days, we saw few social or therapeutic nursing interactions with people who stayed there. There appeared to be an impoverished environment with little therapeutic intervention or meaningful activities to do.

After our visit, we spoke with relatives by telephone, and heard mixed responses about their experience of having a family member stay on either STATT or JSH.

We spoke to staff about their understanding and practice of safeguarding vulnerable adults. Staff could describe many types of abuse but did not mention neglect or institutional abuse.

We toured the building and noted that the environment was not suitably clean for the people who stayed there. We asked the Trust to quickly address this.

The pharmacist found that medicines were not always safely administered. Expiry date checking was not carried out adequately, the emergency oxygen was significantly out of date, and appropriate arrangements were not in place for the storage of medicines. We inspected the emergency equipment, and found some of it was not working. We asked the Trust to immediately address these issues of concern.

We saw that the building was not suitably safe for the people who stayed there, or for people who may visit.

We looked at the quality monitoring checks that took place. These are to enable senior managers to be assured the units are functioning well and safely, and taking people's preferences into account. We found quality monitoring to be inadequate. Whilst much audit work was undertaken, there was little that impacted positively and directly on the care of the people that were being looked after on the STATT unit. There was substantial evidence of ineffective monitoring regarding the health, safety and welfare of people who used the service, and people who worked or visited the STATT unit.

We examined records of people, of staff and of equipment. We found that these were sometimes inaccurate. We asked the Trust to take immediate action on this practice.