The Care Quality Commission (CQC) has told Elysium Healthcare Limited that it must make improvements to The Copse in Weston Super-Mare, following a recent inspection.
The Copse is a long stay, high dependency rehabilitation hospital for adults with enduring mental health issues, to help them transition to living in the community or in supported community placements.
CQC carried out an unannounced focused inspection of the service to look at how safe and well-led it was, as a result of concerns raised about the safe management of medicines and incidents, as well issues relating to staffing.
The inspection began on 10 August but was paused to allow the service to deal with a COVID-19 outbreak, and inspectors did not return to the site for a final visit until 12 October. In the time between inspection visits, CQC carried out further reviews of the service’s care records remotely, and the provider kept CQC updated about changes it had made to the service in response to the feedback given after the first visit in August.
Following the final visit in October, the overall rating for the service dropped from good to requires improvement. The ratings for safe and well-led also dropped from good to requires improvement. Effective, caring and responsive were not inspected on this occasion, therefore the previous ratings of good for all three domains remain.
Karen Bennett-Wilson, CQC’s head of hospital inspection, said:
“Our inspection of The Copse was put on hold to enable the service to deal with an outbreak of COVID-19, but we continued to monitor the service remotely, and we were pleased to see that some improvements had been made by the time we returned to complete our inspection in October. On our first visit, we were concerned that there were not enough registered nursing staff to meet the needs of people using the service, particularly at night. Following our inspection, a new deputy ward manager, seven healthcare assistants and two staff nurses had been appointed.”
“However, there were still a number of issues that needed to be addressed. Risk assessments and risk management plans were often generic and not tailored to patient’s specific needs. The service did not have robust systems in place to ensure that medicines were safely administered, recorded and stored, and we found that patients who had been prescribed high doses of medication used to manage a range of psychotic conditions, such as paranoia and schizophrenia, did not have a care plan in place. We also found that the service did not always take action following incidents to ensure that lessons were learned, and improvements were made. ”
“We have now told the provider to send us an action plan explaining how they will address our concerns and we will continue to monitor the service closely to ensure that improvements are made and fully embedded.”
Inspectors found the following during this inspection:
- Leaders did not display clear oversight of the service. Staff were unsure who held certain areas of responsibility. Monthly clinical governance meetings lacked action plans to address identified concerns
- The service did not always provide safe care. There were times when there were not enough staff on the wards to meet the needs of the patients, especially when responding to emergency calls for assistance. There were occasions when only one registered nurse was on duty at night who was responsible for all medication administration across four wards during the shift and the registered nurse sometimes had to administer controlled medication outside of company policy, without supervision and a signature from a second registered nurse. During these shifts, the registered nurse could not have a break for the whole shift or comfort breaks without leaving the wards without a qualified member of staff
- There was an over reliance on bank and agency staff which meant there were times when patients were not familiar with the staff providing their care. Inspectors were told by staff that occasionally agency staff did not turn up when they were expected to, which contributed to the service being short staffed
- Staff said they did not always feel respected, supported and valued and some said they did not feel they could raise concerns without being reprimanded
- The service did not have robust systems and processes in place to enable staff to safely administer and manage medicines
- Staff did not assess or manage risk well. Identified risks were not recorded properly with appropriate management plans in people’s care records, which meant known risks and concerning behaviours were not safely mitigated
- Restrictions were placed on a patient that did not aid their recovery or promote wellbeing, and there was no rationale recorded to explain the decision-making process which led to these restrictions being used
- Reporting of incidents was not consistent. Staff did not report all incidents in a timely manner and had not reported some incidents to external agencies as required. The service did not reflect on and learn from incidents and share learning across the organisation to improve safety.
However:
- Following the inspection, the service had restructured the ward arrangements and employed an additional ward manager to provide more leadership capacity. Seven healthcare workers, two staff nurses and a deputy ward manager vacancy had also been filled to reduce the number of bank and agency staff used
- Following the initial inspection visit, the service had made some improvements to documentation around risks and risk management plans. Minutes of the multi-disciplinary team meeting were more detailed and included discussions around risks, and some rationale regarding decisions made in relation to people’s care
- A further review of care plans following the initial visit showed that improvements had been made in response to the issues raised. Improvements included accurate identification of risks and management plans appropriate to meet the needs of patients. Physical health needs, medication and food/fluid intake were comprehensively documented, personalised and up-to-date plans were in place
- Inappropriate restrictions that were previously placed on a patient were lifted and the rationale for other interventions were well documented.
Full details of the inspection are given in the report published on our website.
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