Chase Farm Hospital

We spoke with staff on the wards and the management within the service line and the trust, as well as people who used the service and their relatives. We looked at a recent feedback survey which had been carried out on Cornwall Villa and we used a specific tool to observe the manner in which care was being delivered to people who were unable to give us direct feedback about their experiences on Silver Birches. We observed the meal period on each of the wards we visited. We also requested information from the trust which was provided to us.

We found that significant improvements had been made in the service since our last inspection. People and their relatives spoke positively about the care which they received and we observed positive and therapeutic nursing interventions. People's physical healthcare was monitored and work had been done, and was ongoing, to ensure that therapeutic activities met the needs of people with dementia.

We saw that some specific projects had been initiated to ensure that the specific needs of people using the service were met, such as a project on measuring compassionate care particularly where people were not able to communicate easily and a focus on therapeutic activities and occupation for people with dementia.

Understanding and application of the Mental Capacity Act (2005) was significantly improved. The ward environment was checked and the ward environments were clean and hygienic. Records relating to people's care were both complete and comprehensive.

The service had established meetings between the wards so that learning could be shared. We saw that this was evidenced and that the trust had embedded learning across the organisation from the improvement journey which had taken place in the older people's inpatient mental health services. We saw that leadership within the organisation was committed to continual improvement.

This inspection was carried out by three inspectors, an expert advisor, an expert by experience and a pharmacist inspector.

During this inspection, conducted on 25 and 26 September, we visited four wards which were The Oaks, which is an admission and assessment ward for older adults who have functional and organic mental health needs which, at the time of our inspection, was in the process of changing to a ward which will cater for older people with functional mental health needs, Silver Birches, which was a continuing care ward for people with dementia and was in the process of changing to an admission and assessment ward for people with organic mental health needs, including dementia, Cornwall Villas which was a dementia continuing care ward and Bay Tree House which was a rehabilitation and 'step down' ward for older adults with functional mental health needs which had some continuing care beds. The Oaks, Silver Birches and Cornwall Villas are at the Chase Farm Hospital site. Bay Tree House is registered to Chase Farm and located about a mile away from the hospital site.

We visited The Oaks and Silver Birches in the morning and afternoon of 25 September before returning in the evening to observe the night shift. We visited Cornwall Villas in the morning of 25 September and Bay Tree House on the afternoon of the 26 September.

We found that most staff interaction with patients was good but we saw some examples which could still be improved.

Understanding and use of the Mental Health Act (1983) and the Mental Capacity Act (2005) varied between the wards. In some areas we saw that it was used and documented well but on other wards we found that there was a risk that people were subject to restrictions without having access to legal processes and protection.

We found that medication was safely stored and administered.

The Trust had adequate staff on the wards however in some areas there was a high use of agency staff. The Trust had systems in place for monitoring and improving the service but these were not used effectively to improve care across all wards for older adults. We saw that many improvements had been put in place on The Oaks ward where concerns had been raised previously, however we identified similar concerns in other wards.

Personal records, including medical records, were not accurate or fit for purpose. Although we saw records on The Oaks, were comprehensive, on some other wards we found significant gaps in records and some records which were not up to date.

Our overall findings from this inspection are that there are significant improvements in the care provided to patients on The Oaks but that there is non-compliance in many of the same areas on the other wards for older adults. This shows poor leadership as lessons from the failings in one part of the hospital are not being robustly applied across other wards even within the same service area.

Most patients and relatives we spoke with were positive about the care provided on the wards. Some felt that the communication between themselves and the ward staff could be improved.

We observed the staff supporting the patients and saw some examples of positive interaction but also noted some areas where these could be improved.

We found that people were generally having their care needs met. Some activities were taking place, but these were not always planned in a manner that met people's individual needs. People did not always get the support they needed to eat and drink.

We inspected the seclusion rooms and a sample of seclusion records on each ward. We were not able to talk to all the patients whose records we inspected. We did talk privately to one patient. We also talked to staff; two service managers, three ward managers, a deputy ward manager and the Director of Nursing, Quality and Governance.

We found people in seclusion were continuously monitored by ward staff and regular reports made on their condition. We found some good examples of patients' health being looked after while they were in seclusion and afterwards. There was one example where a patient alleged that they hurt themselves in seclusion and there was a lack of written evidence to find out if this was the case.

The provider had made recent improvements to the auditing and recording of seclusion. We found in most cases, people had an opportunity to comment on their experience after being secluded. There were safety issues with some seclusion rooms where there was a lack of written risk assessment on the ward to address the known risks.