Cumbria Partnership NHS Foundation Trust Newapproachcomprehensive Core Service Report (Communityhealth Coreservice Community
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Cumbria Partnership NHS Foundation Trust RNN Community health inpatient services Quality Report Voreda House, Portland Place, Penrith, Cumbria, CA11 7BF Date of inspection visit: 9-13 November 2015, 23-24 Tel: 01228 602000 November 2015 Website:www.cumbriapartnership.nhs.uk Date of publication: 23/03/2016 1 Community health inpatient services Quality Report 23/03/2016 Summary of findings Locations inspected Location ID Name of CQC registered Name of service (e.g. ward/ Postcode location unit/team) of service (ward/ unit/ team) RNNBE Penrith Community Hospital Community Health Inpatient CA11 8HX services RNNBF Brampton War Memorial Community Health Inpatient CA8 1TX Hospital services RNNX6 Ruth Lancaster James Community Health Inpatient CA9 3QX Community Hospital services RNNX2 Abbey View Community Health Inpatient LA14 4LS services RNNY1 Workington Community Hospital Community Health Inpatient CA14 2UF services RNNLG Langdale Unit Community Health Inpatient LA9 7RG services RNNX7 Victoria Cottage Hospital Community Health Inpatient CA15 8EJ services RNNX9 Wigton Community Hospital Community Health Inpatient CA7 9DD services RNNCB Cockermouth Hospital Community Health Inpatient CA13 9HT services This report describes our judgement of the quality of care provided within this core service by Cumbria Partnership NHS Foundation Trust. Where relevant we provide detail of each location or area of service visited. Our judgement is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from people who use services, the public and other organisations. Where applicable, we have reported on each core service provided by Cumbria Partnership NHS Foundation Trust and these are brought together to inform our overall judgement of Cumbria Partnership NHS Foundation Trust 2 Community health inpatient services Quality Report 23/03/2016 Summary of findings Ratings Overall rating for the service Requires improvement ––– Are services safe? Requires improvement ––– Are services effective? Requires improvement ––– Are services caring? Good ––– Are services responsive? Requires improvement ––– Are services well-led? Requires improvement ––– 3 Community health inpatient services Quality Report 23/03/2016 Summary of findings Contents Summary of this inspection Page Overall summary 5 Background to the service 6 Our inspection team 7 Why we carried out this inspection 7 How we carried out this inspection 7 What people who use the provider say 8 Areas for improvement 8 Detailed findings from this inspection The five questions we ask about core services and what we found 9 Action we have told the provider to take 30 4 Community health inpatient services Quality Report 23/03/2016 Summary of findings Overall summary Overall we rated this service as requires improvement. treatment. However, there was limited understanding of the implementation of the Mental Capacity Act (2005) and Staff across all locations reported incidents and the the Deprivation of Liberty Safeguards (2008) across the service had high rate of reporting of incidents. However service. This led to poor recording of individual’s mental we found there was limited evidence of learning from capacity and any decision making processes where a these incidents. Throughout the inspection we saw some person lacked capacity. care records were comprehensive but we found they were not always individualised and some care records lacked The service worked actively with local health and social assessments and care plans. We saw the records were not care organisation to ensure patients’ needs were met standardised across the service. through the way services were organised and delivered but the service lacked an overall strategy and had not Ward areas were very clean and tidy but there was fully engaged with the staff regarding plans for the future. insufficient storage space in a majority of the locations we visited. There was a lack of equipment for staff to use Across the service we found a lack of assurance in to help keep patients safe and some equipment was not governance processes. Many policies were out of date properly checked or maintained. and there was a lack of senior management visibility to most front line staff across the service however the People’s care and treatment was planned following geography of the area covered by the service is very assessment but this was not individualised. There was challenging There was a clinical governance structure, little evidence of current evidence based guidance being but there was limited evidence in the way the service used and no outcome measures were available. robustly managed risks through action planning and Staff were caring and respected people’s privacy and dissemination of information to front line staff. dignity but on occasions we found staffing levels to be Some locations we visited lacked nursing leadership and low which increased the risk of harm to patients. mandatory training and staff appraisal rates were both Most people were involved in their care and treatment below the Trust target. and also in any decisions made regarding their care and 5 Community health inpatient services Quality Report 23/03/2016 Summary of findings Background to the service Community in-patient services at the Trust were • Millom Community Hospital – nine beds managed by the Community Care group. There were a Cumbria was a large, rural county and very sparsely total number of 204 inpatient beds in 13 wards at 12 sites populated in some areas. The community hospital model across the county of Cumbria. addressed the challenges of a location such as this by During the announced inspection we visited nine wards providing a step up and step down service. This service at the following locations: was used by people aged 18 or over from the community and acute NHS Trust hospitals. Cumbria had an older • Ruth Lancaster James Community Hospital at Alston population than the national average with 27% of – seven beds and a Nurse-led Treatment Centre residents aged over 60 compared to 22% nationally. The (open 24 hours) proportion of older people was also increasing at a faster • Brampton War Memorial Hospital – 15 beds rate in Cumbria than it was nationally. In the last 10 years Cumbria’s over 60 population had increased by 16.1%; • Eden Unit at Penrith Hospital – 28 beds compared to a national increase of just 11.6%. This trend • Langdale South and Langdale North wards at was forecasted to continue. Westmorland Hospital, Kendal – 17 beds (beds Some locations provided a minor injuries facility or nurse- closed at the time of inspection) and 23 beds led treatment centres for people aged 5 years and over. respectively These units were open at varying hours across the county • Abbey View at Furness General Hospital in Barrow in and were nurse-led by nurses from the wards at Ruth Furness – 24 beds Lancaster James Community Hospital and Victoria Cottage Hospital. In other locations the minor injuries • Victoria Cottage Hospital at Maryport – 13 beds and a units were run separately to the wards. When required, Nurse-led Treatment centre (open 09:00 to 19:00 medical support in the nurse-led treatment centres was weekdays and 11:00 to 19:00 at weekends and Bank provided by the local General Practitioner or salaried GP, Holidays) but only at times when the surgery was open. All children • Ellerbeck Ward at Workington Community Hospital – under the age of 5 years were seen by a GP if they 14 beds attended these units if there was one available. People were given treatment, advice or referred onto Emergency • Skiddaw View Ward at Wigton Community Hospital – Departments at the acute hospital if required. 19 beds The wards were nurse-led with input from a rehabilitation During the unannounced inspection we visited two wards team consisting of physiotherapists, occupational at the following locations: therapists and rehabilitation assistants. In most locations • Isel Ward at Cockermouth Hospital – 11 beds the rehabilitation teams also provided a service to people in the community. Medical input was from the local GP • Victoria Cottage Hospital at Maryport – 13 beds and a surgery or salaried GPs and the amount of cover varied Nurse-led Treatment centre (open 09:00 to 19:00 across the locations. weekdays and 11:00 to 19:00 at weekends and Bank Holidays) During the inspection we spoke to 37 patients, four relatives, and 62 members of staff. We also reviewed 23 We did not visit any wards at the following locations: care records and six medication administration charts. • Mary Hewetson Cottage Hospital at Keswick – 12 We also attended six meetings including patient beds handover, multi-disciplinary meetings, a focus group and two medication administration rounds. We observed care • Copeland Unit, West Cumberland Hospital at being delivered and meals being provided to people Whitehaven – 15 beds 6 Community health inpatient services Quality Report 23/03/2016 Summary of findings using the service. We reviewed information supplied by complaints and audits from all the wards at all the the Trust for the whole service including incident reports, community hospitals. We received comments from patients and members of the public who contacted us directly to tell us about their experiences of the service. Our inspection team Our inspection team was led by: The team included CQC inspectors and a variety of specialists: consultant psychiatrists, experts by Chair: Paddy Cooney, experience who had personal experience of using or Head of Inspection: Jenny Wilkes, Care Quality caring for someone who uses the type of services we Commission were inspecting, health visitors, Mental Health Act Reviewers, a social worker, pharmacy inspectors, Brian Cranna, Inspection Manager Team Leaders: registered nurses (general, mental health and learning (Mental Health) Care Quality Commission disabilities nurses), a school nurse and senior managers. Sarah Dronsfield, Inspection Manager (Acute) Care Quality Commission Why we carried out this inspection We inspected this core service as part of our comprehensive community health services inspection programme.