Archived: The Huntercombe Hospital - Roehampton

Updated 17 November 2020

The Huntercombe Hospital – Roehampton is provided by Huntercombe (No 13) Limited. It is registered to provide the following regulated activities:

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

• Accommodation for persons who require nursing or personal care

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury

The service provides 28 psychiatric intensive care (PICU) beds. Kingston ward provided care and treatment for up to nine male patients. Upper Richmond provided care and treatment for up to nine female patients, although this ward was closed at the start of June 2020 due to a lack of demand for female PICU beds. A third ward on the hospital site, Lower Richmond, was now an acute admission ward but as part of the COVID -19 infection prevention and control arrangements was being used to nurse patients admitted whilst waiting the result of a test for COVID-19. This is a ten bed ward.

At the time of our inspection Kingston ward was closed due to a fire in August 2020. All patients from the ward were moved to Upper Richmond ward.

We have inspected Huntercombe Hospital – Roehampton ten times since 2010. Reports for these inspections were published between March 2012 and August 2018. Since the CQC began rating services in 2015, the service has been rated as either requires improvement or inadequate. The service was placed in special measures between May 2018 and January 2019.

We have previously inspected the service in January 2019. At this inspection we rated the service overall as requires improvement. We rated the key questions safe and well-led as requires improvement. We rated the key questions effective, caring and responsive as good. We found the following two breaches of regulation. These were in relation to:

Regulation 12 (safe care and treatment) – staff were not familiar with ligature risks and risk mitigation on the wards.

Regulation 17 (good governance) – the governance systems within the hospital were not robust and embedded in assessing the quality and safety of the service.

The last inspection of this service was in November 2019. This was a focused inspection in response to anonymous whistleblowing concerns raised with the Care Quality Commission. We rated the service overall as requires improvement. We rated the key question safe as inadequate and the key question well - led as requires improvement.

At this inspection we found the following four breaches of regulation:

Regulation 9 (person centred care) – patients did not receive care in a therapeutic environment. There was a high use of enhanced observations.

Regulation 12 (safe care and treatment) – staff did not use approved restraint techniques.

Regulation 17 (good governance) – governance systems did not ensure the safe and effective running of the hospital. Lessons learnt from incidents and safeguarding concerns were not shared with relevant staff. The restrictive interventions programme had not been implemented. Agency staff did not have access to the electronic records system, team meetings did not take place, systems to receive feedback on agency staff were not in place and the culture on the wards did not reflect the vision and values of the provider.

Regulation 18 (staffing) – high use of agency staff which impacted on safe and consistent care.

The CQC began enforcement action to close the hospital. This action ended after the provider submitted sufficient evidence to demonstrate significant improvements in the service.

Updated 17 November 2020

The Huntercombe Hospital – Roehampton provides psychiatric intensive care (PICU) services for both male and female patients and an acute ward for male patients. However, at the time of the inspection the female PICU was closed.

Our overall rating of the service improved from requires improvement to good.

This was a focused inspection where we looked at the key questions, are services safe, effective and well led. At our previous inspection in November 2019 we had proposed to the registration of the service. The provider had appealed against this proposed cancellation and provided a detailed plan of how they would improve the service. At this inspection we found these improvements had been made.

A condition to restrict the number of patients to 28 patients at the hospital remains in place.

Our rating for the safe key question improved from inadequate to good. Our rating for the well led key question improved from requires improvement to good. Our rating for effective stayed the same and remains good. Our overall rating of this service changed to good as a result of this inspection.

We rated The Huntercombe Hospital - Roehampton as good because:

• The service had improved its approach to staffing the service. During our last inspection in November 2019, we found that up to 75% of support workers were employed by agencies. These staff did not receive supervision or appraisal. The hospital did not have systems for assessing the skills, experience and competency of these staff. Since that inspection, the hospital had stopped using agency staff and had recruited permanent staff to provide safe care and treatment. Staff said this had led to significant improvements in the culture of the hospital and the quality of care provided to patients.

• Safety had improved. During the last inspection we found that there were frequent disturbances on the wards. Patients said they found the hospital noisy and scary. Since then, the hospital had introduced clear criteria for admission. The service accepted patients who had never been in a PICU providing they met the criteria for admission and that any presenting risks could be managed safely within a PICU setting. Staff reported that the wards were safer.

• The service had introduced a restrictive interventions reduction programme. Staff said there was a greater focus on understanding patients concerns, de-escalation and using restraint in a way that was safe. Staff were committed to only using restrictive interventions as a last resort. Staff received effective training on this and were skilled and experienced. Enhanced observations were used for the least amount of time and reviewed daily by the clinical team.

• The service model and environment had been re-designed since the last inspection. The number of PICU beds had been reduced and the service had introduced a 10 bed acute ward. This was to create a smaller recovery focussed environment and provide a pathway for patients to be cared for in a less restrictive environment.

• When serious incidents occurred, managers carried out thorough investigations and shared the learning from these investigations with the staff. When members of staff raised whistleblowing concerns with the CQC, the manager investigated these concerns promptly, provided thorough responses and acknowledged problems when appropriate.

• All staff spoke positively said they felt supported by the registered manager.

• Staff said that managers communicated well. They said they had opportunities to raise concerns and that managers listened and took action in response.

• The hospital managed matters relating to the COVID-19 pandemic effectively. The hospital had introduced appropriate arrangements for enhanced infection prevention and control. At the time of our inspection, no patients or staff at the hospital had acquired COVID-19.

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

• Staff felt respected, supported and valued. Since the last inspection there were improvements to the culture of the hospital. Staff were provided with opportunities for development and career progression. They could raise any concerns without fear. Staff reported they were positive and proud to work for the provider.

• Governance processes operated effectively, and performance and risk were managed well.

Updated 17 November 2020