Brook House

There were a number of systems in place to check the health, safety and cleanliness of the building. Staff were aware of the individual risks to and from patients’ mental health needs and how the observation, support and monitoring of patients was used to manage risk within the environment. There were sufficient staff on duty to provide appropriate care and treatment to patients. There was good multi-disciplinary input for the size of the mental health hospital as the provider employed an occupational therapist and a social worker.

Patients told us that staff were approachable and they gave them appropriate care and support. We observed staff speaking with patients and providing care and support in a kind, calm, friendly and understanding manner. Patients were treated with dignity and respect. Patient’s relatives were complementary about the respectful care their loved ones received. There was a range of activities that patients could participate in. Information about the providers’ complaint procedure was clearly displayed on the hospital noticeboards. Patients told us that they felt well supported by staff in making complaints. There were some rules due to the nature of the locked rehabilitation role of the hospital. Managers of the hospital should clearly articulate the rationale for any local rule or restriction to both staff and patients through information and policy development.

Staff undertook training and had supervision, team meetings and appraisals to ensure they were competent and confident in their role. Patients were encouraged to give feedback on the quality of the service in various ways such as meetings and surveys. Information was analysed and action taken to maintain and sustain quality services. Regular audits were carried out by various levels of staff within the organisation. The audits themselves were of a good standard and issues identified within audits were usually addressed to improve the quality of services for patients. Whilst staff and managers were committed to providing quality services, it was not fully clear that audits and innovation were embedded within a co-ordinated clinical governance framework.

Brook House could have been more effective because care planning documentation did not always explicitly include sufficient written evidence of holistic individual discharge plans or provide evidence that ongoing

baseline assessment and progress based on rehabilitation and recovery principles. The location had clear procedures in place regarding their use and implementation of the Mental Health Act and the Mental Health Act Code of Practice. However there were issues with section 17 leave recording, a lack of medical scrutiny of detention papers and staff did not have ready access to copies of detention papers at all times.

We did not identify any regulatory breaches on the inspection. We have asked the hospital to consider what they should do to improve services further in some areas.

Mental Health Act responsibilities

We do not rate responsibilities under the Mental Health Act 1983. We use our findings as a determiner in reaching an overall judgement about the Provider.

We carried out routine Mental Health Act monitoring visit in September 2014. Where we found issues relating to the MHA on these monitoring visits, managers of Deepdene Care provided an action statement telling us how they would improve adherence to the MHA and MHA Code of Practice. On this inspection we saw that many of the issues raised had been addressed, for example improved advocacy access had been arranged and the section 17 leave proforma had been amended to ensure patients received a copy.

The hospital had a Mental Health Act administrator who ensured that the responsibilities of the Mental Health Act were met. There were good systems in place to support adherence to the Mental Health Act. The records we saw relating to the Act were generally well kept. The exceptions were:

• the recording of section 17 leave including section 17 leave forms being amended numerous times. The parameters of section 17 leave were also recorded on specific days of the week which did not permit flexibility.

• Staff on the unit did not have access to detention papers out of hours.

• There was no evidence of medical scrutiny of detention papers.