We rated Spring Wood Lodge as good overall because:

• At this inspection the service had acted to address the breaches of regulation identified, as well as areas where we suggested they should take action, following the last inspection. These included physical health monitoring following rapid tranquilisation and for those prescribed medications with side-effects including high-dose anti-psychotics, staff clinical supervision and team meetings, staff understanding of the hospital’s search policy and principles of the Mental Capacity Act, and ensuring correct documentation in relation to patients’ detention and treatment. Whilst there remained some issues in the safe domain, the service has now been rated as good in the effective domain. With existing ratings of good in the caring, responsive and well-led domains the service has now been rated as good overall. Additionally;

• Staff completed a pre-admission risk assessment with each patient which was updated regularly including after any incidents. Staff were aware of, and dealt with, any specific risk issues such as falls. All patients had a care plan specific to their individual needs which was personalised, holistic and recovery-oriented. All staff knew what incidents to report and how to report them and reported incidents when they should, including safeguarding concerns.

• Staff provided a range of care and treatment interventions suitable for the patient group. The staff team included a range of specialists required to meet the needs of patients on the wards. Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group. Managers ensured that staff received the necessary specialist training for their roles.

However:

• At this inspection, whilst improvements had been made following our last inspection of the service, we identified some new areas of concern related to the safety of the service. These included, staff were observed to have painted and false nails, contrary to infection control principles, the clinic room was cluttered and was being used as storage for a number of items and cleaning of the clinic room varied in regularity with records not stipulating how often clinic rooms should be cleaned. Daily checks of emergency bags on both wards were not always completed, and several medications were not labelled with patient details or did not have a date of opening written on them. The service’s protocol detailed that a doctor could attend within 45 minutes of a psychiatric emergency which is against AIMS standards for inpatient mental health rehabilitation services which state a doctor should be able to attend within 30 minutes. Additionally, we did not see evidence that staff were consistently completing patient-led recovery outcome measures which related specifically to patients’ pathway of care, in order to measure effectiveness and safety of interventions as well as patient and carer experience.

The Care Quality Commission are placing this service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We rated Spring Wood Lodge as inadequate because:

• Safety was not a sufficient priority, and there was limited measurement and monitoring of safety. The management of risks in the environment was poor and we found several concerns about the management of medication. Staff were not properly trained and senior staff were not adequately supervised. We found that patients prescribed medications with serious side effects were not monitored appropriately. There were a number of blanket restrictions in place which had led to staff creating punitive punishments for patients.
• Patients were at risk of not receiving effective care and treatment. Staff did not always adhere to the Mental Health Act Code of Practice and consent was not always obtained or recorded in line with the Mental Health Act Code of Practice. Staff were not trained in either Act and their lack of understanding meant that we saw examples of significant impacts on patients whose rights had not been properly upheld. Care plans did not contain the voice of the patient or their views and the language used was directive. There was no evidence that staff completed them collaboratively with patients and their needs, wishes and long term goals were not always measurable or clear. Care plans were not recovery focussed and not all patients had discharge plans in place. This did not fit with a recovery model of care.
• We saw that there were times when people did not feel well supported or cared for because staff did not always see patient’s dignity as a priority. The service was highly restrictive and although patients were involved in the service their concerns were not always responded to in a timely manner. Some care provided to patients was not dignified or respectful, and some restrictions had been put in place for the benefit of staff not patients such as designated staff restricted times when patients were not allowed to request smoking breaks.
• The service was not responsive to the needs of all patients. There were shortfalls in how the needs of different people were taken into account on the grounds of religion or belief. There was no spiritual room available to patients on site, and patients with spiritual and cultural needs did not have care plans which documented and addressed these needs.
• The governance systems in place did not ensure the delivery of safe and high quality care. At the time of inspection the service did not have a manager in post that was registered with the Care Quality Commission and the service did not have an accountable officer to monitor the use of controlled drugs. There was not an effective system in place which identified, captured and managed risks such as audits, training, supervision and environmental risks. The significant issues we found during our inspection had not been identified by the service’s own governance systems. There was no credible statement of values and vision for the service which had been shared with staff. 

We rated Spring Wood Lodge as ‘requires improvement’ because:

• The management of patient’s medications was not always safe. Staff did not always follow national guidance because they did not always monitor the potential side effects of medications when using methods of rapid tranquilisation with patients. Staff were not fully aware of the guidelines in place for searching patients, and the use of a randomiser button when patients returned from unescorted leave.
• Treatment was not always effective because staff did not follow national guidance to monitor the side effects of long term medication use with patients. When patients lacked capacity to make specific decisions, staff did not always act in accordance with the Mental Capacity Act. Not all staff received adequate levels of clinical supervision.
• The governance systems in place were not entirely embedded by the time of the inspection. The service carried out regular audits however; audits in relation to the management of physical health, and the administration of the Mental Health Act had not identified all the concerns we found during the inspection. Staff understanding of certain policies and procedures was not yet entirely embedded. Managers had not ensured that all staff had access to clinical supervision.

However:

• The service had made improvements since the time of our last inspection. It no longer met our rating characteristics of inadequate in the safe and well led key questions, and the provider had put systems in place, which ensured that most areas of concern were on an improvement trajectory.
• The environment was safe and clean. Patients had detailed and thorough risk assessments in place, which staff updated regularly. There were clearly defined and embedded systems and processes in place to keep patients safe and safeguard them from abuse. When incidents occurred staff recorded them well, investigated them appropriately and they utilised the learning of lessons to ensure improvements in safety. Staff used low levels of restrictive physical interventions with patients. Staff had undertaken all required levels of mandatory training.
• Staff provided care, which was compassionate, and empowered patients to be active partners in their care. Patients described staff as kind and caring and we observed this behaviour during our inspection. Patients had access to advocates, and could make complaints and give feedback about the service they received.
• Staff were responsive to the needs of patients. Patients had access to therapies and activities, which met their emotional, spiritual and cultural needs. We saw evidence of discharge planning which was highly person centred.
• The governance processes were joined up with the corporate provider’s objectives and we saw that themes and lessons were shared. The service had employed specialist staff to undertake administration roles which had enhanced the ability of the service to monitor and measure risk and concerns.