One of the most well-known independent mental health hospitals in London has again been rated Requires Improvement overall by the Care Quality Commission.
It was rated Requires Improvement for being safe, effective, responsive and well-led. It was rated Good for being caring, following an inspection in January 2018.
Nightingale Hospital in Marylebone, is an independent hospital that provides mental healthcare and treatment for people. The hospital offers general psychiatry, eating disorder and addiction treatment for adults and general psychiatry and eating disorder treatment to young people, as well as outpatient services.
CQC last inspected the hospital in February 2017. The overall rating for the hospital at that time was Requires Improvement.
At this 2018 inspection, there were a number of improvements needed to ensure patients received safe care.
Building work was taking place to reduce ligature points in the hospital which is anything which could be used to attach a rope or other material for the purpose of hanging. It is not possible for all potential ligature points to be removed. At this inspection staff were not able to clearly explain how they were managing on each ward to keep patients safe from ongoing risks associated with the ligature points which remained.
The hospital had not fully addressed all the actions from a recent fire risk assessment. This meant that in an old building located over four floors, patients might not be safe in the event of a fire.
Staff had not had sufficient training, especially for supporting patients with addictions and eating disorders. Staff did not sufficiently protect patients undertaking detoxification as they were unclear about action to take in the event of alcohol withdrawal seizures or an opiate overdose.
A review of procedures and processes was needed to reduce illicit substances being brought into the hospital and to ensure the measures in place were followed by all staff.
Staff were not always storing, administering and monitoring patients medicines safely.
Clinic rooms, including the fridges which contained patient medication, were not always clean. Cleaning staff did not keep records or schedules for cleaning.
During this inspection, we found that there was still no female only lounge on the mixed sex ward to offer women access to a same gender area.
Complaints were not always addressed appropriately and complainants were not told about the steps they could take if they were not satisfied with the response they received.
Some staff were starting to work in the hospital without their recruitment checks being completed, such as obtaining two written references.
However, patients gave very positive feedback about staff and inspectors saw staff were supportive and kind when interacting with patients. Patients said staff had an understanding of their individual needs and they felt comfortable approaching them. Patients were also positive about the therapies that were available.
CQC has told the hospital that it must take action to address all these areas to ensure patients receive safe care and treatment.
Dr Paul Lelliott, Deputy Chief Inspector (and lead for mental health) said:
“There has been no overall improvement at Nightingale Hospital since we last inspected.
“It is of particular concern that our most recent inspection identified so many basic problems that affect patient safety. It is not acceptable that managers do not work to minimise fire risks, ensure that infection control procedures are followed or that medicines are managed safely.
“However, we did rate the caring key question as Good at Nightingale Hospital. In keeping with this, patients gave very positive feedback about staff there.”
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There has been no overall improvement at Nightingale Hospital since we last inspected
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health)