Archived: Oaktree Manor

We rated Oaktree Manor as good because:

• Managers ensured effective systems were in place to measure the quality of the service. The provider had systems in place to help staff learn lessons from audits, complaints and incidents, through debriefs, team meetings, supervision and bulletins. Managers used these to ensure that sufficient staff were on duty and monitored mandatory training compliance and supervision. The provider operated a system to increase staffing on Fridays to facilitate staff training and administrative tasks without compromising patient care.
• Safe staffing levels had been maintained on all wards. The provider had recruited additional staff since the last inspection and had reduced the use of agency workers from 45% to 30% in the last 12 months. Morale was good and staff teams supported each other effectively.
• Staff compliance with mandatory training compliance was 90%. Staff had access to specialist training in autism and dialectical behavioural therapy. Staff had access to regular supervision.
• Patients were offered debriefs shortly after incidents and periods of seclusion. They were also offered additional debriefs, 48 hours after the event by the psychologist and speech and language therapist.
• Staff completed risk assessments for patients, which were thorough and linked to care plans. Staff completed good quality positive behavioural support plans for all patients, formulated with patient involvement.
• Patients had access to a range of psychological therapies and to a range of activities such as attending a football match, animal care and art therapy.
• Clinical staff completed audits and action was taken as a result. The provider held monthly safeguarding meetings with the local authority and police.
• We observed staff treating patients with kindness, understanding and compassion. Staff understood patients’ needs and were motivated to provide high quality care. Carers and patients told us staff were helpful and polite. Patients had access to advocacy, including independent mental health advocates and independent mental capacity advocates, when needed.
• The service had reviewed how they planned and supported patients towards their discharge from hospital. The service still experienced delayed discharges but had made consistent and considerable efforts to work with commissioners to reduce delays. Every patient had a discharge plan and staff supported patients to contact their community teams.

However:

• Managers had not ensured that staff recognised or recorded that prone restraint techniques were utilised on patients to facilitate safe exits for staff from seclusion rooms. The provider had not ensured all patients received four hourly medical reviews during prolonged periods of seclusion.
• The provider completed ligature risks assessments; however, these did not cover all ligature anchor points.
• Not all patients could access outside space at will, particularly when staff were busy.
• Staff’s use of physical interventions remained high across the service, although this was decreasing. Staff did not always update patient risk assessments after incidents.
• Staff had not ensured all emergency equipment was safe for use. The emergency oxygen mask on Pine ward was out of date and had deflated.
• Staff had not documented best interest decisions for two patients who lacked capacity.
• There was a lack of patient involvement documented in some risk assessments.
• The average length of stay for patients was 918 days across the service. This is higher than the national average of 554 days. The average length of stay on Yellowwood ward was 1150 days.
• Patients stated that food was sometimes ‘greasy’ and choices, including vegetarian options, were limited.
• Multi-faith rooms on the wards did not contain all the required literature or equipment.