Nelson House

Updated 1 December 2023

Nelson House registered with the Care Quality Commission on the 17th of October 2014. The hospital is registered to carry out three regulated activities.

• Assessment or medical treatment for persons detained under the Mental Health Act 1983,

• Diagnostic and screening procedures and

• Treatment of disease, disorder, or injury

To fully understand the experience of people who use services, we always ask the following five questions of every service and provider:

Is it safe?

Is it effective?

Is it caring?

Is it responsive to people’s needs?

Is it well-led?

What people who use the service say

Where patients were informal, they had no restriction placed on them and they were able to leave the hospital freely and staff may ask the anticipated time of return. One informal patient said they were able to “come and go as I please.”

The complaints procedure was on display around the hospital. Patients commented they were confident to approach staff with concerns which were investigated. We joined the weekly community meetings where patients discussed concerns about leave as a group.

One patient said leave to visit family was granted. Other patients stayed in contact with family and friends by phone.

Patients were positive about staff, and they praised the regular staff.

One patient said there had been a lot of changes in decisions between staff. After reviewing comments from staff, it was evident that there were inconsistencies between staff. Some conditions were made more relaxed by some staff. During our visit a staff member told us a patient’s relative was to be told about the possibility of them losing their forward moving placements. It was likely the relative will then discuss with the patient the consequences that led the decision to delay in their discharge.

Patient said they knew their advocate and the support they had from them. One patient said they were accompanied by their advocate to a multidisciplinary team (MDT) meeting. There was signage on the wards with details on how to contact the advocate that visit the hospital.

Patients said they felt safe at the hospital and staff gave them a feeling of safety. They said staffing had improved.

There were notices informing patients on the restricted items including lighters as there was no smoking at the hospital. There were lockers for patients to store any restricted items which they were given access when they were on leave.

One of the 7 patients we spoke with said there were too many “regulations” and too many rules. They said, “staff are too negative.” Staff and patients said that situations were de-escalated, and restrain was minimal.

We observed that all bedrooms were single and en-suite. Some patients agreed for us to enter bedrooms and we saw personal toiletries and they said there was support with personal hygiene and keeping their clothes and bedrooms clean.

While activities were not meaningful and consistently happening across wards for patients, there was a recent group outing, 1 patient was in transition with a phased introduction to supported living and another patient was in full-time education. Comments from patients included “it’s a bit boring,” “can’t do activities.” “Go out for a walk,” “reading, walking, listening to music and cooking sometimes.” Staff also told us planned activities were not taking place consistently. We were told activities were to be reinstated once occupational therapist assistants (OTA) and an activities coordinator were in post.

Updated 1 December 2023

Long stay or rehabilitation mental health wards for working age adults.

Nelson House is a purpose-built 32-bedded independent hospital, operated by the Priory Group, that provides assessment and treatment for men within a locked rehabilitation setting.

The environment was recently re-designated to better meet the purpose of the service. Patients arriving at the service were admitted into Trafalgar Ward and when they were on a discharge pathway moved into Victory Ward for rehabilitation.

At the time of the inspection, the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out this focused inspection since the comprehensive inspection in January 2023. We had concerns about the quality and safety of services. There were recurring themes on the safety of patients, and we were concerned there were risks and that serious incidents would occur.

We inspected Nelson House on 3 occasions since CQC introduced the rating approach of services. Nelson House was rated Requires Improvement in Safe on all inspections and in January 2023 we set requirement notices in care plans and risk assessments and medicines. We asked for the action plans to be submitted 14 days from the publication of the final inspection report dated January 2023. However, these were not provided until the visit in August 2023. The emerging oversight from our visits demonstrate continuous themes and slow to improve areas raised during previous inspections.

Following the inspection we issued a Warning Notice under Section 29A of the Health and Social Care Act 2008 due to our concerns that patients were not receiving safe care and treatment under regulations 12 and 17 of the Health and Social Care Act 2008 (regulated activities)

Updated 1 December 2023

Summary of this service

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service was not fully providing safe care. Risks were not always well managed, they were not always identified, and action plans developed on how to remove or reduce them. There were ligature anchor points in bedrooms and communal space which were not identified in the ligature audit.
• Care plans were not informed by a comprehensive assessment. Care plans were not recovery-oriented and lacked detail on how staff were to meet the needs identified.
• There was a lack of activities and independent living training.
• The lack of documented guidance to staff in care plans and Positive Behaviour Support plans created inconsistencies between staff on how they de-escalated or managed situations where patients placed themselves and others at risk of harm.
• Governance processes were not effective. Shortfalls were not identified in audits and there were no actions on how standards will be met fully. Staff were not having regular line management supervision and compliance to mandatory training rates was below the target set by the organisation.
• Information on how to support patients was not easily accessible and shared with staff. The lack of substantive staff has meant patients’ care and treatment was not consistent.

However:

• Although, managers ensured there were enough nursing and medical staff on duty, there were high numbers of agency and bank staff. This meant there was a lack of consistency in the care and treatment delivered.
• There was low use of restrictive interventions. De-escalation was the main method of preventing behaviours that place people and others at risk of harm. Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff morale was improving. There were better working relationships with staff.
• Staff engaged in clinical audit to evaluate the quality of care they provided.