Saturday, 19 May 2018

Reacting to the CQC Report of the Inpatient Unit I was admitted to | MHAW18

I thought that today, I would do something quite different and react to the latest CQC report of the Adolescent Mental Health Inpatient Unit that I was in, back in 2014. I'm not going to disclose the name of the unit because I don't see the need, I just thought it would be quite interesting to look at. Overall, the Child & Adolescent Mental Health Wards got a rating of Good and the service was last inspected in 2015. I will write my response in italic font, just to avoid any confusion.

Are Services Safe? - Requires Improvement

The two wards inspected were rated as requiring improvement because there was;
  • A number of potential high risk ligature points around both wards
  • The adolescent unit did not have a seclusion room however, the staff were using an Intensive Nursing Area (INA), we were told by staff that they did not seclude patients but the description staff gave of how the INA was used constituted seclusion.
  • Core staffing levels had been set by the trust.
  • The adolescent ward provided clear line of sights when patients were in the main ward area and bedroom corridors.
  • There was two separate corridors which were male and female identified areas and there were gender designated facilities.
  • The ward was clean and there were dedicated cleaners employed. The furnishings were clean and in good repair. 
  • We saw the clinic rooms were well equipped with resuscitation equipment, emergency drugs, a fridge and tools to monitor physical health.
  • There were alarms available to staff and visitors with a call system so staff on the ward could react in an emergency, in the adolescent unit, alarms were not placed in the bedrooms.
  • Staff reported that there were good systems in place to share learning from incidents across the Trust. Staff told us that they knew how to report incidents and were supported after incidents had occurred on the wards.
It has been four years since I was an Inpatient at this particular unit and I can remember off the top of my head at least two ligature points across the parts of the unit that the patients had everyday access to, without a member of staff. I am curious to know if these things have actually been changed since the inspection in May 2015. As an inpatient, we were always told that the INA was essentially seclusion and in the time that I spent there, I only saw few patients with incidents that resulted in them being secluded in the INA. I am surprised that they've been able to get away with not having an actual seclusion area but patients not being secluded is not true because I have witnessed patients myself being secluded in the INA, despite it not being for long periods of time. The unit did have a Girls' corridor and a Boys' corridor with a separate corridor that could alternate between girls and boys, depending on the admissions. We were not allowed down the boys corridor unless it was to go to the INA or to go to Room 16, which is where our belongings were locked away if required. The main areas of the unit were mixed sex and rooms were often unsupervised by staff. The clinic room was out of bounds to patients unless you got called in for observations. Even when inside, the medications and harmful substances were thrown away but I do remember there being a sharps bin which was easily accessible whilst inside the room, which could have lead to incidences. The corridors themselves were visible to staff from the main living area but patients were allowed inside their bedrooms with their doors closed unsupervised and there were many blind points on the unit, where patients couldn't obviously be seen. I will admit, there were cleaners in every day throughout the week, I don't remember if they worked on a weekend or not but they weren't very thorough and there was many places that often got missed or skipped out completely. I remember having to buy baby wipes to clean the furniture within our rooms ourselves. The CQC reported that "parents and patients told us the wards had a homely feel to them" which I wouldn't exactly agree with. The bedrooms were homely, but only because we were able to stick posters and photos on the walls. The furniture was very mismatching and some was quite dated. To me, it looked more like an adult nursery than being homely. The alarms not being in bedrooms seem quite silly to me to be honest, considering that a large percentage of any incidents happened in bedrooms and out of sight of other patients. 

The CQC were told by five members of staff that home visits always go ahead as planned but occasionally local leave and sessions were postponed due to staff shortages. I cannot explain how frustrating it is to be told that you're going on leave with members of staff, for it to then be cancelled due to there not being enough members of staff. We also had a group, every Friday afternoon called Out & About group and you could only go if you have had no incidents in the week, or are making good improvements. Out and About group was often such a motivation, especially if you would be going to somewhere that you really wanted to go and there was a few occasions where many patients had worked so hard throughout the week, for the group to be cancelled due to a shortage of staff, not only because it felt like the hard work had been for nothing, but also because it meant that there wasn't a possibility of getting off of the ward. Training may have been in date but some members of staff really didn't seem to have a clue on how to deal or support a distressed patient which can be so frustrating when you're in a negative mindset. Apparently, according to the CQC report, there were notices on the fire doors within the unit for informal patients who wish to leave and that patients and their families were free to leave at will. This is not true in the slightest, we had two locked doors that couldn't be opened at the same time preventing us from being able to leave, we had to ask permission from our consultant for our families to be able to take us out, which sometimes was denied. We even had to request, wait and sometimes be denied access to the courtyard or garden despite not being detained under the Mental Health Act. Again, according to the CQC report, patients were observed every 30 to 60 minutes depending on their risk, when I was there, the observations went from 1:1, 5 minute checks, 15 minute checks to 30 minute checks but checks were often missed out and at one point, whilst on 5 minute observations, I was left for 35 minutes without an observation, which could have been life-threatening.

Are Services Effective? - Outstanding
The rating given for the Effectiveness of the Service was given outstanding because;
  • All care plans were comprehensive, up to date and reviewed weekly at the ward round or after an incident. They included patient views with a full range of problems and needs. Patients had copies of care plans.
  • Physical health care checks were carried out on admission and reviewed which was evident on all care plans.
  • There was always an experienced member of staff on duty and there was a good skill mix of staff.
  • All staff said how they had attended induction and that specialist training was available as part of the continuous professional development. Clinical supervision was offered and staff attended regularly.
  • Staff were trained in and had good understanding of the Mental Health Act, the Code of Practice and the guiding principles. 
Whilst I was there and after, according to the CQC report, the unit was always short staffed, sometimes more than others but there was almost always at least two qualified nurses on each shift. I can remember a few incidents were there was only one and the ward became extremely unsettled but overall, there was usually two. In April of 2015, there was 76 shift requests filled by 59% bank staff, 24% agency and 18% remained unfilled. Bank staff was my idea of a nightmare, not because of the staff members themselves, but because although some of them regularly did shifts at the unit, many of them we didn't know which made it extremely difficult to be able to talk to a trusted member of staff for support. It also made the ward quite unsettled as there were sometimes two or three strangers walking around the unit at the same time, leaving only a couple of permanent staff members on shift. Despite all training apparently being up to date, staff members told the CQC that it was difficult at times to be released from the ward to attend specialist training, available to them.

Are Services Caring? - Good
Both units were rating as Good for caring because;
  • Patients told us staff treated them with dignity and respect and felt that staff were approachable. We observed interactions with staff, patients and families. We found that staff communicated in a calm and professional way. Staff showed an understanding of individual needs of the patient.
  • Patients were actively involved and participated in their care planning. Patients and families had copies of the care plan.
  • Patients gave feedback on the service they received on monthly patient/parent feedback forms.
I must admit, parents were always full involved in the care of their child, but I felt that sometimes they were too involved. Confidential conversations with therapists and members of staff were kept confidential, but were usually recapped in each weekly ward round, which got sent to our parents. However, it was found that staff members were always available when the patients needed to talk to them which wasn't the case, they'd be busy spells where it was impossible to speak to a staff member or where staff members would say how they'd come to speak to you, and they never did. One issue that did arise on a comment card was that patients were discharged too early, resulting in them having to be readmitted and I thought that this was so accurate. There were so many other patients being discharged whilst I was an inpatient, far too early and many did end up readmitted. I was told that I was being discharged but that I would probably be facing another admission within the next couple of months. Thankfully, that didn't happen but I feel that many people, come out worse than what they went in as. I disagree with the apparent fact that patients were actively involved with their care planning, I think that I was asked once what I thought my triggers and risks were and after that, my care plan was never updated alongside me. Having said all of this, on a feedback service, the unit only scored 64% for staff supporting patients to feel safe on the ward.

Are Services Responsive to people's needs? - Good
The units were rated as good for being responsiveness because;
  • There was a full range of rooms and equipment to support treatment and care on the ward and in the classroom. There were quiet areas on the wards. The outside space was used. Patients were involved in choosing the colours of the walls and art work.
  • We found examples of how staff supported patients to raise complaints. Staff told us they had access to interpreters and translation services as and when this service was required.
  • We found a wide range of information leaflets were available to patients and families.
  • Patients told us that cook chill food was of poor quality and tasted bland.
Before I start, I firstly must confirm that Cook Chill, or Cook Kill as we called it, was absolutely disgusting. It was delivered to the unit, pre-made and just had to be heated up in a machine before being served. The food was mushy, bad quality and did not taste nice. Thank-god that we had a cook for lunch time and weekends because I think that I ate cook chill maybe three times within my whole admission, it was so bad that instead of eating it, we'd go to tesco with staff members and buy our own food. On a survey, only 44% of patients said that they liked the food, and I am guessing that when they said they liked the food, they meant the cook's food. We were allowed access to our mobile phones which I am so thankful for as it meant that we didn't lose complete touch with the real world. There was internet available on the ward but only through the computers set up, we had to be a bit sneaky and steal the password code from the Eating Disorder Unit next door to have wifi on our phones, which one patient got off a friend in the neighboring unit.

Are Services well-lead? - Good
The services were rated good for being well-lead because;
  • Managers had access to trust data and used this to gauge the performance of the team and compare against others.
  • Staff reported good morale and being supported by their colleagues.
  • A range of audits took place to assess the quality of the service.
According to the CQC detailed report, Staff members were aware of the executive team but were unsure of the organisation's values, which isn't very promising. There was a high staff turnover in the unit, which could be so stressful, especially if you were to become attached to a staff member. According to the CQC, this was due to the fact that many staff members were newly qualified and wanted to move on, to gain further experience. Overall, staff members said how they enjoyed their job despite it sometimes being stressful. I think that most of the staff members that I knew, did act like they liked their jobs but there were the odd few who obviously felt otherwise. I felt that when an incident or issue was raised by a patient, the staff members communicated well and all relevant information was documented. 

Overall, there is so much that I could say about this unit, both good and bad, I feel that there were some quite big issues with the unit that weren't inspected by the CQC but I will leave it at that for today.

Thank-you for reading, Tay x

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