A ward for older people who use mental health services at a south London mental health trust needs to improve according to the Care Quality Commission.
Oaktree Lodge, is a 17 bed ward providing continuing care to older people with mental health problems. The ward, part of Oxleas NHS Foundation Trust, provides care and treatment to male and female patients, and most patients need support with their physical health as well.
This unannounced inspection, which took place in April 2018, was carried out following a safeguarding adult investigation, which had upheld allegations of poor care provided to a patient.
All of the trust’s wards for older adults with mental health problems were inspected in April 2016. At that time, the core service was rated as Good. This inspection just looked at some aspects of how one ward provided care and so the rating of the care service was not reviewed.
During the April 2018 focused inspection CQC found that:
Staff communication with patients on the ward was not always therapeutic. Inspectors observed a member of staff telling a patient she would be ‘jabbed’ if she did not take her medicines.
Patients sat in the communal areas of the ward with little to occupy them. Staff appeared to spend more time talking with each other than with patients.
The recording of patients’ capacity to make decisions was poor, particularly when decisions were made not to resuscitate a patient if their heart stopped. Other people said that staff were sometimes dismissive of patients and were pre-occupied with routine and tasks.
The leadership team on the ward were unable to monitor and maintain good standards of care and treatment for all patients.
However, inspectors did note that when patients were at risk of falls, staff completed a falls risk assessment. Patients at risk of pressure ulcers were also assessed appropriately.
Specialist staff, including dietitians, physiotherapists and district nurses came to the ward following a referral. The palliative care team also attended the ward when this was necessary. All patients had an annual physical health check.
Action the trust must now take to improve the service included:
- The trust must ensure that patients are involved in their care to the maximum extent possible. This must include decisions regarding future treatment.
- Oxleas must ensure that risk assessments of patients are undertaken following admission to the ward and are reviewed regularly. Action must be taken to minimise potential risks.
- The provider must ensure that patients are treated with dignity and respect and that staff interact appropriately with patients.
- It must ensure that patients can undertake activities, which promote their autonomy and independence.
- The trust must ensure an effective system is in place to assess, monitor and improve the quality and safety of care provided to patients.
Jane Ray, CQC’s Head of Hospital Inspection (Mental Health), said:
“It is a matter of some concern that standards on this ward at Oxleas NHS Foundation Trust have slipped.
“I want to see the trust quickly adopt our recommendations and make sure care at Oaktree Lodge is improved quickly.”
Helen Smith, Acting Chief Executive at Oxleas said: “We were very concerned to hear about the areas CQC identified for improvement. The Board and Executive team were absolutely determined to make the required improvements as quickly as possible and to ensure that all patients in Oaktree Lodge receive high quality, personalised care. I’m pleased to confirm that the Taskforce we established to oversee this process is completing its work according to plan, and we look forward to welcoming the CQC back to the unit for a further inspection."
You can read the report in full on our website.
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It is a matter of some concern that standards on this ward at Oxleas NHS Foundation Trust have slipped
Jane Ray, CQC’s Head of Hospital Inspection (Mental Health)