During our previous visit in April 2013 we said the provider must improve the way they gained patient’s consent to care and treatment, and how they assessed people’s capacity to consent. This was in relation to those patients who were not subject to any restrictions under sections of the Mental Health Act, 1983.

We visited again in July 2013 to review the actions the provider had told us they would take.

We saw there were clear systems in place to assess patients’ capacity to consent to their care and treatment. The systems included information about advanced decisions, arrangements for acting in patients’ best interests and any input from advocates.

When we visited 35 patients were receiving care and treatment within the hospital. 28 of the patients were detained under various sections of the Mental Health Act, 1983.

During our visit we spoke with two patients, five members of staff, a clinical manager and the registered manager for the hospital.

We looked at five patient’s care records in detail and other records kept within the hospital such as staff recruitment and training records. We also spent time observing how patient’s were supported to receive their care and treatment.

Patient’s had individualised care plans and received the care and treatment set out in those plans. For some patient’s there was no documentation about their capacity to consent to care and treatment, or records to show they had been asked for their consent. This meant the provider could not be sure they were acting in accordance with patient’s wishes or in their best interests. We said the provider must take action to address this issue.

Staff were recruited to work within the hospital in a way which promoted patient's safety. They had received training in subjects which helped them to meet patient’s needs.

Patients we spoke with told us they were generally happy living at the home. One patient told us staff helped them to join in with activities they enjoyed and another patient told us staff listened to what they had to say. Patients also said they felt safe living within the hospital.

During this visit we followed up on three areas of non-compliance identified in a previous inspection. We reviewed evidence that demonstrated the provider's compliance in these outcome areas.

We spoke to one person who lived at the hospital and they told us about how staff helped them to manage the risks involved with their care.

We spoke with a number of patients within the hospital, and we also used a range of different ways to help us understand their experiences. This was because some patients had complex needs which meant that they were not able to tell us about their care and support experiences. For example, we looked at records, including personal care plans, we spoke to the managers and staff who were supporting patients, and we observed how they provided that support.

We saw patients were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect. The quality assurance systems that were in place encouraged patients to express their views about the services they received, and be involved in improving the services where necessary.

In general we saw that patients were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the hospital.

Patients told us things like, “My key worker is nice, she helps me a lot”, “Yes I feel very safe, the staff are nice here” and “I would speak with the manager if I was worried about anything.”

However we saw that there were areas where the provider needed to make improvements to the service that patients received. For example, we identified issues with medicines management, management of moving and handling needs, and the general hospital environment.

There were 41 patients at Healthlinc House when we visited. We met most of the patients and spoke to five of them in more depth to get their views of the service.

The patients we spoke with were positive in their views. They told us they were involved in planning and reviewing the care and support they needed. Patients said that staff were “kind and polite” and had helped them to move on. They told us about the range of activities they enjoyed. Patients told us they felt safe at Healthlinc House.

We rated Heathlinc House as good because:

• Managers discussed staffing levels daily in the morning management meeting and deployed staff to take into account individual patient need and risk. We saw that a qualified nurse was often in the communal areas of the service, although a support worker was present in the communal areas at all times.
• Medicines were stored securely and in accordance with the provider policy and manufacturers’ guidelines. We reviewed eight prescription charts which were completed correctly. Each chart had a “use of as required medication protocol” form which gave direction on when to administer as required medication as well as guidance to staff for reporting issues to the prescriber.
• Staff treated patients with kindness, compassion and respect. We observed interactions between staff and patients and saw that staff were responsive to patient's needs. We observed support given to patients at meal times. Staff treated patients with dignity and were caring. Staff interacted with patients at a level that was appropriate to individual needs.
• Doctors followed National Institute for Health and Clinical Excellence (NICE) guidelines when prescribing medication. We reviewed eight medication charts which showed that antipsychotic prescribing met with NICE guidelines. Patients had access to psychological therapies recommended by NICE. These included the use of functional assessments to identify behaviours that challenge, dialectical behaviour therapy and the use of positive behavioural support plans.
• Patients knew how to complain. The hospital displayed pictorial information on how to make complaints. We spoke with eight patients, all of which said they knew how to complain.
• Staff were aware of how to manage complaints. Staff we spoke to knew the complaints process and was able to respond appropriately and support patients to make a complaint if required.

However:

• Staff did not record room temperatures of all clinic rooms. We found several gaps in the recordings for clinic room two. This could have affected the efficacy of the medication stored in the room.
• Managers had not ensured that polices were kept up to date. We reviewed 10 hospital policies, all of which had expired; the date for review was February 2014. We brought this to the attention of the managers who assured us policies were adhered. The manager provided an action plan which highlighted that all polices would be updated by August 2017.