This inspection relates to a review of specialist drug services provided under the registered location Highgate Mental Health Centre. A range of inpatient and community based services are included in this location, and we will carry out additional inspections and report on these separately.

One inspector visited the service over the course of a day. We spoke with people who use the service and with staff. We also examined a range of records relating to the running of the service.

We found that people who use the service understood the support and treatment options available to them. People who use the service told us that they were “listened to”, that the service was “flexible” and that they felt that staff “took the time to explain and discuss things”.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The people we spoke with felt they had been given appropriate information to make decisions about their care and treatment.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the provider had appropriate arrangements in place to store, manage and dispense people’s medicines. The provider had an effective system to regularly assess and monitor the quality of service that people received.

This inspection relates to a review of inpatient services provided under the registered location Highgate Mental Health Centre. A range of outpatient and community based services are included in this location, and we will carry out additional inspections and report on these separately.

Seven inspectors and one Mental Health Act Commissioner visited the Highgate Mental Health Centre over the course of a day. We visited

Malachite, Opal, Topaz, Garnet, Amber and Coral Wards. A range of services were provided on the wards we visited including acute inpatient services, psychiatric intensive care services, rehabilitation and older people’s services. On Garnet ward where people who use the service experienced dementia we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Patients we spoke to commented:

“This is better than some of the other hospitals I have been admitted to”

“My rights were explained to me”

“I have been given enough information about my treatment, and I am feeling better”

“All my medications have been properly explained to me”

“The doctor has explained everything about my treatment very clearly”

“I think my medication has side effects, but I’m not sure what they are which worries me”

“I have been here a long time, I’m not sure what is happening about me moving on, and there isn’t enough to do on the ward”

“They do art on the ward, but I’m not interested in this”

“It can be quite boring on the ward, there isn’t enough to do”

“I usually get my escorted leave when I need it”

“Things have gone okay since I have been here”

“There is always someone to talk to if I am worried about anything”

“The staff are very friendly, and have been very approachable”

“The staff have got to know me really well during my stay”

“I have been here for five days, there has been talk about my care plan but I haven’t seen it yet”

“I am not happy with my care plan, I wasn’t consulted about it”

“I don’t think I have a care plan, I haven’t seen a copy”

“We have talked about my care plan, but I don’t have a copy of it”

Patients we spoke with felt that they had been given sufficient information about their care and treatment. However, some people using the service were not aware of their rights and the potential side effects of medication prescribed for them. We were concerned that this might mean that patients did not have sufficient information about their care and treatment options.

Patients we spoke with told us that they thought their privacy and dignity were respected. They also commented that any physical health problems they had experienced during admission had been addressed. Patients told us that they knew the nursing staff on their ward and felt comfortable talking with them. We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. However there was a lack of awareness by some patients about what a care plan was, whether they had one, and what was in it. This could mean some patients did not have sufficient information about their care plan to ensure that they could make informed decisions about their care and treatment. Some patients we spoke with commented on the lack of appropriate activities available on some wards.

We found that the provider responded appropriately to any allegation of abuse. The patients we spoke with commented that they felt safe on their wards. Patients told us that if they felt unhappy or worried they were comfortable speaking to staff about this. From our discussions with staff we found that most staff understood the training they had received about safeguarding, but that a few staff could not demonstrate an understanding of the signs of abuse and the aspects of safeguarding processes that were relevant to their role.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We found that premises were mainly suitable, accessible and generally well maintained. We also found that the premises were largely clean and hygienic and free from offensive odours. On the day of our visit we found that some patients right to privacy, dignity and autonomy were not being promoted by the routine locking of communal rooms on one ward and by observation panels in bedroom doors that could not be closed from inside the room. During our visits to acute wards we found that the ensuite bathrooms contained a mixture of anti ligature and standard fittings. We were concerned that the provider could not evidence that the risks of self harm associated with standard fittings in bathrooms on these wards had been assessed and addressed.

Overall, during our visit we found there were enough qualified, skilled, and experienced staff to meet people’s needs. We observed that staff knew the needs of people using the service meaning that patients received consistency of care. However, some staff and patients commented that there were insufficient staff on duty at the weekends, and that activities co-ordination was frequently an additional role for nursing staff which could mean these did not take place.

We saw that copies of the provider’s complaints procedure was displayed on each of the wards we visited. The patient’s we spoke with were aware of the complaints procedure.

The provider had systems in place to gather, record and evaluate information about the quality of the service provided and to analyse adverse events and incidents to establish what caused them and to learn from these. We did however find variations in the quality of service provided between wards. Whilst the provider had systems in place to gather information about the service provided we were concerned that inconsistencies in the service provided and the potential risks of non compliance had not been identified.