Archived: Harcourt House

Updated 1 June 2016

At the time of the inspection Harcourt House provided care, treatment and support for people with acquired brain injury. The service offered neuropsychological rehabilitation. There were eight patients at the hospital. Three patients were detained under the Mental Health Act 1983 (MHA) and four patients were detained under the Deprivation of Liberty safeguards (DoLs). One patient was not detained.

Harcourt House was registered to provide assessment or medical treatment for persons

detained under the Mental Health act 1983 and treatment of disease, disorder or injury.

There had been no registered manager for the service for eleven months.

The service received referrals from statutory services from inside and outside of London.

Harcourt House had been inspected five times since 2010. Inspections took place in July 2012, December 2012, January 2014, March 2015 and July 2015. Following the inspection in July 2015, we issued two requirement notices. These related to the management of medicines and the lack of effective systems to assess, monitor and improve the quality and safety of the services provided. During this inspection we found that these continued to be areas of concern.

Updated 1 June 2016

We decided to cancel the registration of this service. This means the provider will no longer be able to operate the service at this location.

We rated Harcourt House as inadequate because:

• When a patient was restrained this was not always recorded as an incident. Staff did not always recognise physical interventions as restraint. Patient’s physical observations were not taken during or after restraint or rapid tranquilisation.

• There had been 27 serious incidents in the previous year. The service did not have an incident policy. Not all incidents were reported.

• One patient had been locked in their room for several weeks. This had not been recognised as long-term segregation. The patient was not detained under the Mental Health Act. This was a breach of the patient’s human rights and amounted to mistreatment.

• One patient’s bedroom had a stained floor and an overwhelming smell of urine. The service was not clean and was neglected. Redecoration and maintenance were required. The environment was institutional.

• Patient’s risk assessments did not include all potential patient risks. Risk assessments and management plans were not updated after incidents, including serious incidents.

• Safeguarding incidents did not always result in a safeguarding referral. Less than 60% of staff had undertaken safeguarding adults training. The provider could not ensure that it could protect patients from avoidable harm.

• The pads for the defibrillator, to restart a person’s heart, had expired in 2009. An oxygen cylinder was unsecured. Had it fallen it could have led to an explosion of gas.

• Patients did not receive psychological treatment appropriate to their needs. Patient’s care plans did not include their psychological, spiritual and cultural needs. Patients were not involved in developing their care plans.

• The number of qualified nurses did not ensure that patients received safe, effective and high quality care. Some staff, including senior staff, were not skilled and experienced in the care and treatment of people with a brain injury. There was a low rate for staff attending specialist training.

• Patients were not always treated with dignity and respect. Patient’s receiving insulin had to expose their stomach in public to receive their medicine. When staff had contact with patients for physical therapy they wore gloves.

• Patients reported they did not feel listened to by staff. Patients were unable to access an advocate easily. Patients said they were bored and there were very few activities. There was no activity programme in the service.

• There was no effective system for ensuring that best practice and legal requirements were met regarding the Mental Health Act and the Mental Capacity Act.

• There was a lack of clinical audit. Important standards for the care, treatment and safety of patients were not monitored. There had been a systemic failure to assess, monitor and improve the safety, care and treatment of patients.

The provider closed the service two weeks after we conducted the inspection.

Updated 1 June 2016