Antelope House

We inspected on 2 December 2013 to review the progress the provider had made. We found that the provider had taken some steps to improve care planning and medicine records. However, although the care plans were individualised for mental health needs they did not always detail the support and care each patient required for physical health needs. Records such as risk assessments did not reflect concerns related to patients' physical health.

We issued a warning notice to the provider stating our concerns with continued non-compliance, stating that they needed to have taken action by 31 January 2014.

We inspected on the 6 February 2014 to review the progress the provider had made with regard to the warning notice and the concerns we had with the care and welfare plans for patients.

At this visit we chose to inspect care plan records on all four wards at Antelope House: Trinity, Saxon, Hamtum and Abbey. Some patients were there informally (not detained under the Mental Health Act 1983) and some were detained under the Mental Health Act 1983. We were accompanied by the senior nurse lead for the directorate. We looked at 10 care plans spoke with eight staff, the acute care pathways manager who managed Antelope House and the senior medical clinicians for the service. We spoke with 3 patients about their care.

We met with the acute pathways manager and senior nurse lead before we started our inspection and they explained to us the action they had taken to meet the warning notice. This included an open discussion about how they were working to change the practice at Antelope House, for example, the learning department were more proactive with training and implementing multi-disciplinary team working with the staff having signed up to working collaboratively with each other and the patients. Staff confirmed that there was protected time for two hours in the morning and one hour in the afternoon, this allowed staff to mix/integrate with patients. Occupational therapists had been asked to support people using the service during the protected time. We were told consultants were assessing junior doctors clerking and assessing with use of an audit tool. The senior staff told us that there has been confirmation that staffing will be invested in to improve skill mix of staff for example investment in psychology, occupational therapy and general trained staff.

Senior staff told us that they were looking at staffing and how staff vacancies were covered. We were told that senior staff had chosen to close Trinity ward to new admissions rather than bring in agency staff, because there were a number of patients who required one to one staffing. A daily situation report for staffing, vacancies, sickness, concerns had been implemented in order to manage the staffing to meet patient needs. Senior staff explained about their plans for long term agency staff, to have a pool of appropriately trained agency staff. 'We can't be satisfied with unsatisfactory agency staff'. The pool of staff would receive same training as permanent staff in order that the management of Antelope House could be assured that all staff were trained to meet the needs of patients.

We found that three wards had taken sufficient action to meet the warning notice.

However, concerns remained regarding Hamtum ward. There continued to be a lack of information in risk assessments and care plans regarding patient's physical health needs, placing patients at risk of not receiving care to meet their needs. We also identified that staff on this ward were not well supported in that they were not confident in planning care or taking action for patients with physical health needs. The other three wards had taken action, staff had been supported and there was collaboration amongst the staff groups to ensure that changes were made. However, there was a lack of collaboration and assessment of the work that was talking place to ensure all the wards at Antelope House were compliant.

We spoke with six members of staff working in the ward environment and four patients. We also spoke to senior managers on site such as the acute care pathways manager and lead nurse.

We observed staff being respectful, asking people if they needed support. The atmosphere on Trinity ward was relaxed with a member of staff playing their guitar. Whilst on Hamtum ward the atmosphere was variable as there were patients' expressing themselves loudly and they were not feeling well.

We carried out an inspection in August 2013 when we identified concerns with care and welfare and medicine records. We made compliance actions asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and they sent us an update on their actions in October 2013.

We inspected on 2 December 2013 to review the progress the provider had made. We found that the provider had taken some steps to improve care planning and medicine records. However, although the care plans were individualised for mental health needs they did not always detail the support and care each patient required for physical health needs. Records such as risk assessments did not reflect concerns related to patients' physical health. The improvement in medicine records was not consistent. We identified concerns regarding keeping stock safe and the administration of medicines.

We identified concerns with the monitoring and assessment of the service in that audits carried out had not identified issues and work had not been carried out to ensure that all actions taken and changes made, had been embedded into practice.

Patients we spoke with gave contradictory opinions. For example one was happy with the service and was involved in their care and treatment choices, they felt 'listened to'. Another patient however did not feel heard and did not think their equality and diversity needs were respected. Overall we found that patients received the care they needed.

We observed a nurse discussing the medication needs of a patient with them and ensuring they were involved in the management of their medicines. We observed staff encouraging and supporting a patient who had put themselves on the floor, to get up. We observed staff being respectful, observing patient's behaviours so they were aware of when they may need to intervene and offer support. This was balanced with offering choices and asking patients if they needed support and assisting when asked. However we found that medicines were not disposed of following the trust's policy.

Staff told us about the training they have received and the support they had from senior staff. Senior managers work with staff to monitor and assess the quality of the service.