Bilberry unit is managed by Villa Care Limited. The unit supports patients aged 60 years plus who are medically optimised for discharge and have finished their acute episode of care at local NHS Trust hospitals. These patients are waiting whilst assessment or packages of care are put in place or are awaiting placement into a nursing or care home. The service has worked in partnership with the local NHS Trust under a service level agreement. Patients are cared for by nursing and health care staff from Villa Care Limited and medical and therapy staff input is provided by the acute trust. A social work team employed by the local authority is based in the hospital and supports discharge planning.
Patients deemed suitable are transferred to the wards from the acute NHS Trust and remain a trust patient until they were finally discharged from the service.
The service is based on Heather ward and Bilberry ward at the Wharfedale Hospital in Otley. The Bilberry unit comprises of side rooms and bay accommodation. Male and female patients are nursed in separate bay areas and/or side rooms.
We inspected this service using our comprehensive inspection methodology and carried out an unannounced inspection on 12 February 2019.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
Services we rate
We rated it as Good overall.
A shared governance system was in place with the local NHS Trust. The registered manager worked closely with the chief nurse from the local NHS Trust who had ultimate responsibility for governance.
The incidents we reviewed at the inspection showed that staff had learned from recognised incidents. Managers had investigated incidents and had shared lessons learned with the team.
The service treated concerns and complaints seriously, investigated them and shared these with all staff.
The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
The service was awarded a ‘Bronze’ award through the metrics award system for having achieved consistently high metrics results.
Managers had the right skills and abilities to run the service. The service had adopted a values-based behavioural framework and staff described a positive culture where managers, staff and the multidisciplinary team worked well together.
The service had enough staff with the right qualifications, and experience and to provide the right care and treatment. Managers appraised staff’s work performance as a means of development.
Nurse and care support staffing levels were adequate. The planned level of nurse staffing was met on the day of our visit and the staffing rota showed planned staffing levels were achieved.
There was evidence of multidisciplinary working on both wards. The unit discharge co-ordinator worked closely with the acute NHS Trust and social workers to facilitate the safe and timely discharge of patients from the wards.
Service provision on the wards had improved patients’ outcomes. The service had worked closely with the local NHS Trust’s therapy teams to enable patients to benefit from an improved therapy perspective.
Staff showed compassion and provided emotional support to patients and supported patients and those close to them in decisions about their care and treatment. Feedback from patients confirmed staff treated them well and with kindness.
The service planned and provided services that met and took account of the individual needs of local people. Care and treatment was based on national guidance and managers checked that staff followed this guidance.
The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively. The service was proud they had reached the final stage of the Health Service Journal Partnership Awards 2019. These awards showcased the most effective partnerships between the private sector, third sector and the NHS.
The service had suitable premises and equipment. Equipment and premises were visibly clean, and staff used control measures to prevent the spread of infection.
Following this inspection, we told the provider it must take some actions to comply with the regulations and it should make other improvements, as a regulation had been breached, to help the service improve.
However, we also found the following issues that the service provider needs to improve:
Staff knowledge, understanding and application was poor in some areas for example safeguarding, consent and the mental capacity act.
Staff we spoke with did not know what female genital mutilation or radicalisation was. Two staff were unaware of how to access the safeguarding policy.
An ongoing review of patients’ capacity had not taken place whilst in the Bilberry unit.
Bed rails were in place on five patients’ beds on Heather ward. Deprivation of Liberty Safeguards (DoLS) documentation was completed for four patients, however, one patients’ documentation was out of date. One patient who had bed rails had no DoLS documentation completed. The unit followed the Acute NHS Trust Hospital policy for bedrails and deprivation of liberty (DoLS). The provider confirmed that all service users had a bedrail assessment in place and the presence of bedrails did not automatically require a DoLS process to be initiated. We did not see a copy of the Trust policy for bedrails and DoLS.
Staff were not always responding to patients call bells in a timely way.
Patients records were not always kept up to date and gaps were noted in patient documentation. Some patients’ complex needs, and outcomes were not identified.
Patients discharge plans were not always commenced on admission to the Bilberry unit and it was not always clear who led on some patients discharge. Following the inspection, the provider confirmed that the patients discharge process was led by the adult social care team.
On Heather ward nurses gave medication without question therefore we were not assured staff would challenge potentially dangerous medication doses.
We also issued the provider with two requirement notices that affected The Bilberry Unit Details are at the end of the report.
Ellen Armistead
Deputy Chief Inspector of Hospitals (Hospitals)