Archived: Mundesley Hospital

Updated 18 September 2017

Mundesley Hospital registered with the Care Quality Commission in December 2015 and admitted patients for the first time in February 2016. It is registered to carry out the following regulated activities:

• Assessment and treatment for persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder or injury.

Mundesley Hospital is a private mental health care facility located in the North Norfolk countryside. The hospital has 27 beds for adults who require assessment and treatment in an inpatient setting. Patients are either informal or detained under the Mental Health Act (1983).

The hospital provides acute inpatient care for patients requiring urgent and immediate treatment for their mental health condition.

There are six suites located over two floors.

On the ground floor, there are two adjoining inpatient suites, Middleton and Crome. Middleton can accommodate up to six patients and Crome up to five patients.

On the first floor, there are four in-patient suites. Thirtle, Stannard, Vincent and Bright can accommodate four patients each. Thirtle and Stannard are designated female in-patient suites. Vincent and Bright are for either male or female patients. During inspection, two suites were not in use.

A registered manager was in place at the location. The registered manager, Catherine Guelbert, along with the registered provider, is legally responsible and accountable for compliance with the requirements of the Health and Social Care Act 2008 and associated regulations, including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2010. Catherine Guelbert is also the Chief Executive of Mundesley Hospital.

We followed up with an unannounced focussed inspection in January 2017. This inspection was not rated. We reviewed compliance with the warning notice and found that the warning notice requirements had not all been met. There was evidence of progress in some areas however we found further evidence of poor practice. A further warning notice was issued in February 2017 providing clear evidence of concerns.

Due to our concerns the hospital was issued with a warning notice and was placed in Special Measures.

Following our inspection in January 2017 we issued the provider with a number of requirement notices and another warning notice.

• The provider must ensure that all staff are up to date with Mental Health Act training.
• The provider must ensure that all qualified staff receive immediate life support training.
• The provider must ensure that all incidents are reported via their internal reporting process.
• The provider must ensure there are appropriate systems in place to learn from incidents and share that learning with all staff.
• The provider must ensure that staff monitor and record the physical health of patients who have received rapid tranquillisation.
• The provider must ensure that the escorting of patients around the building is based on a clinical assessment of individual risk.
• The provider must ensure that care plans are completed fully and are detailed, and based upon individual risk assessment. The risk assessments must be updated regularly, with clear management plans in place.
• The provider must ensure that physical health nursing assessments are completed and areas of need are addressed.
• The provider must ensure that contemporaneous notes are legible, detailed, in chronological order and reflect patient progress.
• The provider must ensure that all clinical audits have an action plan in place to address the quality of care and concerns identified.
• The provider must ensure that the Mental Health Act Code of Practice (2015) is adhered to in the respect of caring for patients in long-term segregation.
• The provider must ensure patients are aware where CCTV is in operation.

Updated 18 September 2017

CQC first inspected Mundesley Hospital in September 2016. Following that inspection, we rated the service as inadequate. Due to our concerns, we issued the hospital with a warning notice and placed it into special measures. CQC carried out a focussed, unannounced inspection of the hospital in January 2017 to check on progress against the warning notice and to look at some additional concerns that were raised with CQC.

In June 2017, we carried out a further announced, comprehensive inspection to reassess the service six months after we decided to place it into special measures. During this inspection we reviewed progress against the warning notice and the requirement notices. Although we found that the service had addressed some of our previous concerns, we have once again rated Mundesley Hospital as inadequate. This is because:

• We identified a serious incident where staff did not report an incident of restraint through the hospital reporting system.
• This matter was also not reported to safeguarding. We could not be assured that staff were transparent in alerting the hospital’s management or external bodies about incidents.
• We saw evidence of a culture where staff did not always respond to patients’ needs. For instance, we saw several staff eating breakfast whilst a patient waited to enter the dining area. We saw several different staff ignore a patient who knocked at the office door.
• The hospital had an informal feel and staff spoke of a family environment. There was some evidence that the informality bordered on poor conduct, with some staff lacking a professional approach. Some patients complained of staff gossiping about each other in front of them.
• Some patients commented on the difference between the care they received during the day and the night. They reported that at night, staff were not as caring and were less approachable.
• Four patients reported that staff sometimes fell asleep on duty when they were meant to be observing the patient.
• We saw inconsistencies in documentation of enhanced observations on the recording sheets. This meant we could not be sure that the staff carried out observation entries in a timely manner. This also fuelled concern that observations may not have been carried out according to policy. Failure to carry out observations could result in harm to the patient. We raised this with senior managers following the second part of the inspection.
• We found one box of medication that staff had not labelled correctly. Staff had written the name of the medication on the box stating the tablet strength was 2.5mg. We checked the contents and the box held 5mg tablets. This may have resulted in an administration of medication error. This box had been in use for a period of time and this had not been identified through audit. We raised this concern with the provider immediately for investigation and action.
• We saw that staff requested all patients complete a permission form to carry out a body search regardless of their individual risk at admission and following leave from the hospital.This practice meant staff searched patients without considered reason of individual circumstance or risk. Following a serious incident the hospital advised the inspection team of a change of process to ensure only patients with known risk were searched following leave.  Patient records did not clearly state if searches carried out were due to known risk. The provider continued to carry out body searches at admission.
• There was no access to any kind of psychology service. We did not see evidence of any other psychology support such as staff trained in DBT (dialectical behaviour therapy), art therapy or psycho-educational therapies.
• The provider failed to provide CQC with accurate pre inspection information about staffing. For example, the provider submitted information that there was a vacancy rate of just under 2% for registered nurses. During inspection we saw a vacancy rate of over 80%.  
• During inspection the hospital provided figures of 90% compliance of supervision. Staff records we reviewed did not support this.
• There was a serious incident of self-harm on the ward. This incident was reported by front line staff. The detail within the verbal account provided during the inspection was misleading. We challenged the provider who acknowledged that incorrect information had been given.
• Areas of risk to patients were not being managed effectively by the organisation. For example, the provider had not proactively identified areas of poor practice identified throughout this report. Internal audit and management systems had not identified areas of poor practice and how the service could improve.

However:

• The hospital had addressed most of the concerns raised in the warning notice issued following the inspection in January 2017.
• Admission paperwork was completed, physical health needs were assessed, identified and plans were in place to address patients’ needs.
• We saw evidence of contingency and crisis planning with most patients.
• Contemporaneous notes were in order, mostly legible and showed patient progress.
• We saw an excellent handover. The staff conducted it in a careful and considered manner, identified patient need and highlighted areas of risk while describing the management plan.
• Managers had introduced a system to ensure that staff reviewed incidents and learned lessons.

Updated 18 September 2017

We rated this service as inadequate.