We were accompanied on the site visit by our colleague, Sarah Cooke, from the Mental Health Act Commission. One of the Care Quality Commissions (CQC) roles as a regulator is to keep the use of the Mental Health Act under review and check that the Act is being used properly. Our Mental Health Act Commissioners perform this work by visiting all the places where people who are detained under the Mental Health Act stay and producing visit feedback summary reports and an annual statement regarding their findings. The findings of the visiting Compliance Inspector and Commissioner are reflected within the main body of this report.

On balance the people who use the service said they were generally satisfied with the quality of the care and support they received whilst staying on Avalon ward.

One person told us: “The ward has really helped me out. I feel I have got my life back. I could not have done it without the staff here.”

We received a lot of positive feedback from the people who use the service about opportunities they had to express their views about the ward and influence how it was run. People told us they have designated key-workers who they meet every week and attend daily community meetings with their fellow peers and ward staff. Typical comments made by people who use the service, included: “You can talk to the staff on the ward. Most are pretty approachable”, “I like my key-worker, I meet up with them at least twice a week”, and “The community meetings are a relatively new thing and I think they are working well.”

The feedback we received from people about the availability of useful information about their rights, access to independent advocacy services and the wards daily routines was more mixed. Most people told us staff had informed them about their rights under the Mental Health Act when they first arrived on the ward, but no one could recall being told about the role of independent advocacy services or receiving any written information about how the day-to-day running of the ward. For example, activity timetables, the Trusts complaints procedure, ward visiting times.

People told us there was usually enough to do during the day to keep them amused, and one person said they particularly liked the art and cooking classes arranged by the wards Occupational Therapist (OT).

However, most people also expressed being frustrated that there were not always enough opportunities for them to engage in purely recreational activities that were age and gender appropriate, which is more of any issue during the evenings and at weekends when there is normally less staff on duty. Typical comments we received, included: “it can get boring on the ward sometimes”, “It would be nice to do some more fun stuff, especially at the weekends”, and “Have things such as a DVD night, some structured playing of board games or Wii Games that do not involve physical activity would be welcome.”

It was clear from the comments we received from the people who use the service that they are not involved in the planning of their care. Most felt they had very little input in the care planning process. People’s feedback can be summarised as follows: “I have not been given a copy of my care plan. I think it would be useful to have one and I do not know why we are not given a copy” and ”I know I have definitely got a care plan, but apart from talking to my key-worker I do not get involved in helping staff write my care plan.”

The feedback we received from people about the quality and choice of the meals available was on balance positive. People we interviewed told us there was always a good choice of meals to choose from at mealtimes.

People also told us they felt safe on the ward. Typical comments we received, included: “Most of the staff here treat you well. Always polite” and “I have never felt in any danger here on Avalon. If I was worried I would tell the staff.”

People told us they were happy with the physical layout and overall décor of the ward. Typical comments we received, included: “My bedroom is not exactly large, but it’s comfortable”, “Always clean on the ward”, and “There’s lots of places on the ward you can be by yourself or sit with the others.”

We were struck by the bright and pleasant nature of the ward and noticed there was lots of communal space. We also welcomed the fact that only one person currently occupied one of the wards three bedded bays, which are clearly not large enough to accommodate three people comfortably.

None of the men and women we interviewed felt their privacy or dignity was impaired by the fact the ward was mixed gender. However we noted that there are no single gender areas on the ward as recommended by the Code of Practice, which the wards manager has agreed to look into.

We received a lot of very positive feedback from the people about the attitude of the staff who worked on the ward. People spoke very highly about most of the wards permanent staff team and said they always treated them with respect. Typical comments, included: “The staff are great here” and “Best thing about the ward is the staff.” We observed staff interacting with the people who use the service in a kind and courteous manner throughout our visit.

However, people also told us they felt staff were often too busy to be able to spend much quality time with them. Many people felt that there was a lot of ‘agency staff’ being used on the ward whom they did not feel able to approach as they were perceived as not having sufficient expertise to support people with eating disorders. Typical comments we received, included: “the agency staff are nice, but they do not know us that well” and “They have too many agency staff working here. It’s not their fault, but they are not as good as the proper staff.” These negative points notwithstanding the wards manager was confident the service would have its full compliment of suitably qualified permanent staff by the end of October 2011 following a successful staff recruitment drive.

We would like to thank the staff on the ward, particularly the Ward Manager and Modern Matron, for facilitating this visit and speaking openly with us.

On balance the people we spoke with on the wards were generally satisfied with the standard of care and support they were receiving at Springfield University Hospital.

Respecting and involving people

The overwhelming majority of the comments we received from people about the staff who worked on the wards was positive. Most people we met told us staff always treated them with dignity and respect, and generally listened to what they had to say. Typical comments included - “the staff are great here - very supportive”, “they (staff) are always polite – never rude”, and “if im not happy about something I’d talk to my key-worker or the nurse in charge about it - staff do listen to you”.

Visiting inspectors observed some positive interactions between staff and people using the services. The majority of staff working on the wards we visited were seen interacting with people in a very kind, caring and respectful manner.

The feedback we received from most people about information staff gave them and the opportunities they had to express their views were mainly positive. Visiting inspectors reported finding evidence that one-to-one and peer group meetings were being held on a routine basis on all the wards in some form or another. We also noted lots of information in easy to read and understand formats conspicuously displayed on all the wards we visited, which most people we met told us they found interesting and informative. For example, notice boards in communal areas on most wards contained up to date information about meal choices and times, weekly activities timetables, details about how to contact independent advocacy services; and the names of all the staff who were on duty that day.

We received positive feedback about the work being carried out by the independent advocacy services, although we our aware there are no advocacy services available for the children and young people. We feel children and young people with mental health problems who are also hearing impaired are particularly vulnerable and would benefit from having access to independent advocacy who could speak on their behalf.

Activities

Most people we met talked about there being a good range of therapeutic, social and physical activities being available on the wards from Monday to Friday, but we received a number of negative comments about a lack of community based and meaningful recreational activities being available at weekends. People using the services and staff told us this was mainly due to staff shortages on certain wards. Comments made included – “there are plenty of things to do to keep us occupied in the daytime”, “I get angry sometimes because I’m bored at the weekends”, and “we sometimes go bowling and swimming, but only if there’s enough staff around”.

Consent to treatment

The responses we received from people about staff keeping them informed about their rights while they stayed at Springfield University Hospital and them consenting to their treatment were mixed.

While most people told us staff had been good at providing them with information about their rights under the Mental Health Act when they were first admitted to their ward, there were a number of examples of a failure to make repeated or further attempts to give people using the services information, for example, if they did not understand their rights, or when their section had been renewed.

Furthermore, the majority of staff we spoke with did not always seem to be fully aware that individuals who had been informally admitted to the ward had the right to leave whenever they chose.

Care plans

All the children and young people staying at Corner House and the people on Heather ward we met said they had been given copies of their care plan.

However, the vast majority of the people we spoke with on the other wards we visited told us they believed they had a care plan, but had never actually seen or been given of it. Some of the care plans we scrutinized contained some good person centred information to help staff meet these individuals’ needs, although the quality of there content varied considerably. Furthermore, most people we met told us they had not been involved in planning their care and treatment.

Typical comments we received about care plans included – “staff can be a bit secretive about your care plan - I had to ask staff five times before I saw a copy of my care plan”, “I’m pretty sure I’ve got a care plan on the computer, but I’ve never actually seen it”, “staff have never talked to me about my care plan”, and “I don’t feel I’ve got any control over my care plan – it’s just something for staff to use”.

Meals and mealtimes

Most people we met told us they liked the food that was being served on the wards and the variety. A number of people we met said the overall quality and portion sizes of the meals had significantly improved in the past year. Typical comments we received included - “the food is great – I would recommend it”, “I’d give most meals 8 out of 10”, “we usually have three or four meals to choose from”, “there’s always a veggie option”, and “when I don’t like what’s on the menu I order a takeaway or cook something myself”.

However, visiting inspectors who observed lunch being served on a number of different wards reported seeing mixed practises. On some wards lots of staff took the opportunity over lunch to sit and talk to people using the service, while on other wards very few staff tended to be present at this time and those that were often remained standing. We felt there were some missed opportunities for staff to make the mealtime a much more positive and social experience for all involved.

Safeguarding people from abuse

The majority of people we met told us they felt safe on the wards they were on. Comments included - “I feel safe here”, and “it can be a bit unsettling when new people arrive, but I always feel safe because there’s always enough staff about”.

Environment

The vast majority of the people we met told us the wards were usually kept clean, smelt odour free, and generally felt comfortably warm. Typical comments included - “the ward is usually kept very clean and it’s always nice and warm here”, “it’s never dirty on the ward”, and “we sometimes run out of soap and paper towels in the toilets, but staff are pretty good at replacing them when you tell them”. The overall cleanliness of all the wards we visited was good.

Most of the wards we visited had been refurbished in the past couple of years and the majority of the people we spoke with who were staying on these wards were very complimentary about all the improvements made to their surroundings. Typical comments included – “the ward looks a hundred times better since the re-fit - I think the painters did a good job”, and “I’ve got everything I need in my bedroom, including somewhere to lock my valuables away”.

We received some rather mixed responses from the children and young people staying at Corner House and people on Heather ward, which were not included in the Trusts refurbishment program. Comments made by the people we met who were staying on these wards included – “its pretty comfortable here, but as you can see it’s a bit frayed around the edges – its seen better days”, and “it’s alright here, although some of the bedrooms could do with a lick of paint. The Board of Directors and staff working on these wards all confirmed it was the Trusts intention to close both of them within the next 18 months, but in the interim work would continue to be carried out to improve the interior of these wards to make them look and feel more comfortable for the people staying there up until the end of 2012. Read the full inspection report (PDF)

Springfield University Hospital is part of South West London and St George's Mental Health NHS Trust. It provides a range of mental health inpatient and outpatient services including, acute, rehabilitation, older people, eating disorder and forensic services. The trust is responsible for providing all the community and hospital-based psychiatric services to the London Boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth.

We found that the services at Springfield University Hospital were safe, the wards were clean and staff were aware of risks. There were ways to report and learn from incidents, but improvements were needed in assessing and managing risks to people's safety.

Staff interacted with people who used the service in a caring and compassionate way. People and their relatives were involved in planning their own care, although records did not always reflect this. People were engaged in activities they felt were meaningful and therapeutic. Ward staff listened to people’s feedback and involved them in making positive changes.

The Mental Health Act responsibilities were being discharged appropriately. Some actions from previous Mental Health Act monitoring visits had not been fully resolved.

We saw good examples of learning from audits and incidents being shared, and changes to practice being made as a result.

All staff we spoke to on the ward told us they received training for safeguarding children and vulnerable adults as part of their annual mandatory training. They also said they would be confident in reporting safeguarding – either internally or to the local authority.

Staff told us they felt supported by the management on the ward and their immediate managers. Some staff told us they did not always feel involved in conversations about their roles, particularly when organisational changes were taking place.

We found that the recording of rapid tranquilisation on some wards was not being done well. We saw routes of administration being recorded incorrectly, doses of medicines being recorded in progress notes but not on medicines administration records, and patients who were administered these medicines did not have a reason for the use in their progress notes.

We visited the following wards at Springfield University Hospital as part of this inspection:

Ward 1

Core service provided: Psychiatric Intensive Care Unit (PICU)

Male/female/mixed: male

Capacity: 13 beds

Ward 2

Core service provided: Acute admission ward

Male/female/mixed: mixed

Capacity: 18 beds

Ward 3

Core service provided: Acute admission ward

Male/female/mixed: mixed

Capacity: 20 beds

Jupiter Ward

Core service provided: Acute admission ward

Male/female/mixed: mixed

Capacity: 23 beds

Bluebell Ward

Core service provided: Acute admission ward for deaf adults

Male/female/mixed: mixed

Capacity: 16 beds

Corner House

Core service provided: Specialist assessment and treatment unit for deaf children and adolescents aged 8 to 18

Male/female/mixed: mixed

Capacity: 6 beds

Avalon

Core service provided: Eating disorder service

Male/female/mixed: mixed

Capacity: 18 beds

Wisteria Ward

Core service provided: Young poeples eating disorder service

Male/female/mixed: mixed

Capacity: 10 beds

Crocus Ward

Core service provided: Services for older people

Male/female/mixed: mixed

Capacity: 21 beds

Haswell Ward

Core service provided: Medium secure forensic ward

Male/female/mixed: male

Capacity: 16 beds

Hume Ward

Core service provided: Low secure forensic ward

Male/female/mixed: male

Capacity: 16 beds

Phoenix Ward

Core service provided: Secure rehabilitation ward

Male/female/mixed: mixed

Capacity: 18 beds

Ruby Ward

Core service provided: Medium secure forensic ward

Male/female/mixed: female

Capacity: 10 beds

Turner Ward

Core service provided: Medium secure forensic ward

Male/female/mixed: male

Capacity: 18 beds

Seacole Ward

Core service provided: Inpatient OCD service

Male/female/mixed: mixed

Capacity: 13 beds

Aquarius Unit

Core service provided: Child and adolescent mental health service (CAMHS)

Male/female/mixed: mixed

Capacity: 10 beds