The Care Quality Commission (CQC) has rated Sherwood Lodge Independent Healthcare, Weston-super-Mare, inadequate overall and has told the provider that it must make a number of improvements.
CQC carried out an unannounced comprehensive inspection of the hospital in May and June.
Sherwood Lodge is a small independent mental health hospital providing NHS funded community rehabilitative care and treatment, and care to adults with mental health disorders.
During the inspection, a number of concerns were raised with the provider of the service and inspectors asked that it took action to make some immediate improvements to the environment and equipment, the way risks were assessed for patients and how care was planned.
During the inspection CQC wrote to the provider to seek assurances that the immediate issues raised on inspection had been/were being addressed to reduce the risk of harm to patients. The provider sent us an action plan and although we were assured that patients weren’t at immediate risk of harm there is still much for the provider to do to ensure improvements continue and are embedded. We also identified that the environment needs significant attention to ensure it can meet the needs of patients going forward.
Sherwood Lodge Independent Healthcare’s rating has dropped from good to inadequate overall. The service’s ratings for whether it was safe and well-led have also dropped from good to inadequate, and its ratings for being effective, caring and responsive have all dropped from good to requires improvement.
Karen Bennett-Wilson, CQC’s head of inspection, said:
“When we inspected Sherwood Lodge Independent Healthcare, we were concerned to find that the leadership team didn’t have a clear understanding of what was required to deliver good quality, contemporary community rehabilitation services alongside providing care for people who may be detained under the Mental Health Act.”
“Our immediate concerns were such that we issued a letter to the provider of the service, to seek assurances about steps it would take to ensure people’s safety.
“Although there was assurance that patients weren’t at immediate risk of harm, there is still much for the provider to do to bring services up to the standard expected..
“We also found some safeguarding incidents had not been reported as required, despite the provider telling us that all staff have received relevant training. When safeguarding reports were made, managers weren’t fully investigating the incidents to understand the cause and implement changes to minimise the risk of reoccurrence. There was no systematic approach to sharing learning from such incidents so practice could be improved.
“The environment wasn’t fit for purpose, and it was difficult to see how staff - despite their best efforts - could provide rehabilitative care in it.
“Many bedrooms were very small, some only a single bed’s length, with limited space to move around.
“Some bedrooms had partition walls to try and create single rooms. These partitions didn’t allow some patients to control their access to natural light/darkness or ventilation as there was no window in these portioned rooms. Both sides of the partitioned rooms compromised patients’ privacy and dignity.
“We also found there was limited room and facilities to support therapeutic activities. Outside space was limited and mainly taken up by a covered courtyard, generally used by smokers.
“The service knows what it must now do to ensure the required improvements are implemented. We will monitor its progress and return to check that these have been made and fully embedded.”
Inspectors found the following during this inspection:
Staff didn’t always recognise and report potential patient abuse or patient safety incidents. Inspectors also found that managers didn’t fully investigate incidents and use them as opportunities to identify learning and ensure patients were protected against the risk of abuse.
Patients didn’t have easy access to professional teams including occupational therapists and clinical psychologists in line with a rehabilitation and recovery model of care.
Personal emergency evacuation procedure plans for some patients were incomplete and didn’t reflect patient needs. Three patients were identified in their care records as requiring support with moving, but their personal emergency evacuation plans identified that they should move independently to the evacuation meeting point.
Some care plans were out of date and didn’t reflect patients’ needs. This included night care plans that referred to patients as not needing personal care during the evening. This is despite having separate care plans that identified them as needing support with this.
There were ligature points throughout the service. Managers had completed a ligature audit, but this didn’t include reference to all potential ligature points, and staff were unaware of how to manage identified risks.
Following the inspection, the environmental audit was updated to reflect risks and shared with staff.
Staff said the service didn’t accept patients with specific suicidal risks. However, inspectors noted care records showing some patients had been identified as being at risk of suicide, and there had been some recent instances of self-harming.
The environment and equipment weren’t well maintained. There was broken furniture and other damaged items throughout the premises. The clinic equipment was overdue calibration and a service.
Staff hadn’t completed comprehensive assessments of patient needs to ensure the suitability of the environment and allocation of upstairs bedrooms.
Staff imposed some restrictions on patients including limiting access to bedrooms and imposing financial charges on one patient for damages caused when they were experiencing challenges with their mental health.