Improvements required at private mental health hospital with high levels of restraint

INSPECTORS say improvements are required at a private mental health hospital in Warrington after finding high use of restraint on some wards, with others not clean and poorly maintained.

The inspection by the Care Quality Commission (CQC) revealed that Arbury Court at Winwick requires improvements for safety, effectiveness and caring but was good for being responsive to people’s needs and being well-led.

Arbury Court is an independent hospital, part of Elysium Healthcare Limited and was registered with CQC on 21 October 2016.
Arbury Court is registered to provide the following regulated activities:
• Treatment of disease, disorder or injury
• Diagnostic and screening procedures
• Assessment or medical treatment for persons detained under the Mental Health Act

The hospital has 82 beds for women aged over 18 years, with mental health needs. All patients were detained under the Mental Health Act. Five of the six wards provided forensic or secure services, and one ward was a psychiatric intensive care unit.

The inspection took place between August 8-10 this year and revealed some of the ward environments were not always clean or well-maintained. Two of the wards were not clean and some areas of the wards were poorly maintained which presented risks on the ward. The service did not ensure that infection control risks were eliminated from food preparation areas.
Also, staff did not always minimise the use of restrictive practices. There were high uses of restraint, on some of the wards.
There was also a high use of prone restraint. Prone restraint means that a person is restrained in a face-down position. Levels of blanket restrictions were high, and it was not always clear why these restrictions were in place.
Staff did not always carry out restraints safely.
Staff did not always manage medicines safely. Medicines cards on some wards were confusing which increased the risk of medication errors. We also found some concerns with Mental Health Act medication paperwork.
Staff did not always respect patient’s privacy and dignity on all wards. Inspectors observed conversations about patients between staff in busy bedroom corridors.
Staff did not always actively involve patients, families and carers in care decisions and communication with families was sometimes poor on some wards.

The levels of restraint were high, particularly on Alderley ward which had taken on a cohort of patients who had learning disabilities. This was concerning due to the vulnerability of these patients. 2912 episodes of physical intervention had taken place across the forensics wards in the 6 months prior to the inspection, with 1377 of these taking place on Alderley ward.
There was also a high level of prone restraint taking place with 68 episodes of prone restraint in the 6 months prior to the visit, 39 of these episodes took place on Alderley ward. 47 episodes of prone restraint were used to administer intramuscular medication.
However, the hospital had high levels of acuity on most wards, with many patients who had complex needs and high levels of self-harm. There was clear evidence that managers were monitoring restraint. There was also evidence a plan was in place to reduce levels of restraint and that levels of restraint including levels of prone restraint were reducing.
Training was in place for staff and there was a person-centred approach to training. Some of the restraints used were guiding restraints where patients were gently encouraged to leave an area, and these were included in restraint figures.

However, the inspectors found staff had completed a range of mandatory training that was appropriate to the needs of the service.
There were systems in place for managing the ward environment, ligature risk assessments were up to date and security checks were carried out regularly. The wards had enough nurses and doctors. Staff assessed and managed risk well, and patients all had up-to-date, relevant risk assessments.
Staff also followed good practice with respect to safeguarding. Staff had received appropriate safeguarding training and there were systems in place to support staff make safeguarding referrals when required.
Staff mostly treated patients with compassion and kindness and understood the individual’s needs.
The service was well led, and the governance processes ensured that ward procedures ran smoothly. Leaders had a good understanding of the service. There were systems in place for monitoring and managing risk and managers collated and used this information effectively and the service had a culture of learning.

The inspection team spoke with 27 patients and 7 carers. They also reviewed patient and carer surveys conducted by the hospital.
Most patients shared positive feedback. Patients told inspectors the staff were lovely, that staff were good and very friendly and that they felt safe on the ward and felt staff cared about them.
Carers said they enjoyed using the café on site for visits.
However, patients on one of the forensics wards were less positive about staff. Some patients said they did not feel safe on the ward and said that staff were not always responsive. Inspectors observed staff, on one ward, talking amongst themselves and not interacting with patients. Some patients said the night staff were not as good as the day staff and some patients said that agency staff were not always supportive.
Patients on the PICU ward said staff understood their needs and that they cared about them. Patients on this ward knew staff well and there was clearly a lot of interaction. For example, a patient was seen completing a daily fitness regime and a member of staff was recording their activity so the patient could monitor their performance.

A spokesperson for Elysium Healthcare said: “The safety and wellbeing of our patients is always our highest priority, and we are grateful to the CQC for this latest inspection report.
“We were pleased to be rated ‘Good’ in the areas of leadership and being responsive to people’s needs, however, we recognise there are still improvements to be made, particularly with regard to staff training following our successful recruitment drive.
“We are committed to the ongoing improvement of our vital services, and we continue to work closely with the CQC.”

A full copy of the report can be read by CLICKING HERE