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					                                                                                                        APPENDIX 1.
                         Mental Health Act Commission Visit Update
                                        March 2006 – May 2006

  Site     Visit Date    Ward                MHAC Comments                              CNWL Response
Paterson   30.03.06      Henry        Day Room/Lounge area needing              Upholstery work remains on going
                        Maudsley       general attention.                         expected completion date is the end
                                                                                  of July.
                                      Poor bathroom facilities, old and         Domestic services contacted and
                                       dirty bath, shower with no drain           the bath thoroughly cleaned.
                                      No dedicated smoking room                 Result of lack of space on the ward
                                       resulting in passive smoking risk to       smoking is only allowed in the
                                       other patients.                            lounge area. Smoking elsewhere
                                                                                  on the ward would cause significant
                                                                                  risk issues.
                                      Possible ligature point in bathroom       Towel rail checked and permanently
                                       (metal towel rail).                        removed.
                                      Weekly community meeting not              Ward Manger to ensure meeting
                                       taking place, last meeting held more       takes place and that minutes are
                                       than a month ago.                          distributed and file copy kept.
                                      Patients complaining of not enough        Staff reminded of the minimum
                                       one to one time with key workers.          standard expected (at least 2 x 1:1
                                                                                  sessions per week). Discussed in
                                                                                  supervision and a weekly audit to be
                                                                                  carried out by all deputies.
                                      Request from patient to access            Arranged as per Trust policy.
                                       health records.
                                      Only two women on ward, one               Patients request to move to an open
                                       complained of feeling harassed and         ward facilitated on the 2.4.06.
                                       that staff do not take her concerns
                                      Patients complained about the poor        Staff reminded of the ward policy on
                                       quality of food and lack of tea and        the provision of hot drinks and to
                                       coffee at meal times.                      ensure they are served at set times
                                                                                  but also on request. Quality of food

                                                                                     to be reviewed with site support
                                                                                     manager and with patients and staff.
                                         Patient requested help in getting in      Patient assisted and contact made.
                                          touch with a relative.
                                         Some files did not contain legal and      Filing system now updated and staff
                                          medical documents.                         reminded to keep filing up to date.
                                         Patients complaining of not having        Issue discussed in staff meeting and
                                          their medication explained to them,        staff reminded of their duty. Clinical
                                          claim supported by lack of evidence        Services Manager written to RMO’s
                                          in the notes.                              reminding them of their duties.
                                                                                     Trust wide consent audit to be
                                                                                     repeated at the end of 2006.

  Site      Visit Date     Ward                 MHAC Comments                              CNWL Response
Woodfield   30.05.06     Bluebell &      No comments or issues raised              No response required
 Road                    Sycamore

 Site    Visit Date   Ward              MHAC Comments                               CNWL Response
Gordon   28.03.06     Ebury      Extended use of S62 for one                Highlighted problem resolved and
                                  patient. Request that the Trust             required certificate to treat
                                  include S62 audit in the audit cycle.       completed. S62 to be included in
                                                                              the consent audit taking place
                                                                              towards the end of 2006.
                                 Front of medicine charts often             Staff reminded to fully complete all
                                  incomplete or blank.                        details on the front of medicine
                                 Review the quality of printing for         Poor quality forms removed and
                                  forms such as S132, S17 and S62.            ward supplies replenished with
                                                                              clean copies. Staff reminded that all
                                                                              forms are available electronically via
                                 No direct access to fresh air.             Patients assessed in line with Risk
                                                                              Assessment Policy as to suitability
                                                                              for visits to the roof garden.
                                 Limited activities on the ward,            Activity Co-ordinator post now filled.
                                  vacant Activities Co-ordinator post
                                  and only 0.5 WTE for OT post.
                                 Request to remind patients that            All patients reminded that rooms
                                  there rooms can be locked to                could be locked. Information to be
                                  secure possessions.                         included in a new leaflet that the
                                                                              ward is developing.

 Site    Visit Date    Ward               MHAC Comments                                 CNWL Response
Gordon   24.04.06     Vincent      Repairs /replacement of the chairs           No plans to replace, as smoking
                                    in the smoking room.                          room will be taken out of circulation
                                                                                  as of December 2006. At the point
                                                                                  of re-commissioning the room will
                                                                                  be refurbished.
                                   Bathroom light not working and               Faults reported and problem fixed.
                                    cover removed.
                                   Both patient telephones out of order         Both patient phones are now fixed.
                                    compromising patient privacy.
                                   Possible ligature risks with some            Health & Safety assessment already
                                    windows.                                      carried out and the windows cleared
                                                                                  with no identified risk.
                                   Report that one patient had been             Random searches take place and
                                    offered drugs whilst on the ward.             unit works closely with local police.
                                   Patient attacked by another patient          All staff attend mandatory training
                                    whilst on the ward, request for all           on the management of violence and
                                    staff to be aware of policy relating to       aggression on a yearly basis.
                                    patient safety.
                                   Complaints that patients not getting         A protected time initiative has been
                                    enough 1:1 time with staff.                   introduced to address the problem.
                                   Some patients did not have copies            Team Leaders reminded primary
                                    of their care plan.                           nurses during supervision.
                                   Request from patients for the group          Group Room already available
                                    room to be opened more frequently.            between the hours of 9am – 10pm
                                   One patient complained of not                Staff engaged with physical health
                                    receiving appropriate care for a              care team and patients foot now
                                    physical injury to his foot.                  healed.
                                   Patient requesting S17 leave to visit        Patient assessed and considered to
                                    his mother.                                   be clinically unwell to be given

                                   2 patients complained of not being           Patients had been informed of their
                                    informed of their legal status and            rights. Staff endeavour to read
                                    not given their rights. Staff needed          rights as soon as possible and at a
                                    to be reminded by visiting                    time best suited for the patient.
                                    Commissioner of the need to read              Staff have been reminded that care
                                     patients their rights.                    plans should include regular
                                                                               reminders to repeat this process.

   Site      Visit Date   Ward             MHAC Comments                             CNWL Response
St Charles   29.03.06     Nile      Complaint that patient had been          Complaint investigated and found to
                                     assaulted by staff and manhandled         be unfounded.
                                     back to his room.
                                    Patient treated in the absence of a      Discussed with RMO who could
                                     valid Form 38/39 and no S62 form          substantiate the treating of patient
                                     present.                                  using S62 as an entry in the notes
                                                                               had been made. No form S62 had
                                                                               been completed and the RMO was
                                                                               reminded of the need to do so.
                                    Persistent problem with bed              Acknowledged as a problem and
                                     blocking.                                 explained initiatives in pace to move
                                                                               people on. Often the result of a lack
                                                                               of onward placements.
                                    Heard from staff about the               Staffing levels currently good with 5
                                     pressures experienced from working        staff during the day and 4 at night.
                                     on the ward and difficulties with         Staff encouraged to take regular
                                     maintaining high levels of                breaks on shift and to use days off
                                     motivation.                               to rest.
                                    Complaints about the lack of fresh       Arrangement made for fresh fruit to
                                     food particularly fruit and               be delivered daily with all meals.
                                     vegetables.                               New catering contract came into
                                                                               force on the 24.4.06 so
                                                                               improvements expected.

 Site    Visit Date    Ward               MHAC Comments                               CNWL Response
Gordon    12.5.06     Gerrard      Staffing levels thought to be              Review of all inpatient services
                                    inadequate making 1:1 sessions              taking place, which will include
                                    with patients difficult and ward            consideration of staffing levels.
                                    rounds depriving the ward of a
                                    qualified member of staff.
                                   Insufficient provision of activities.      Activity Co-ordinator recruited.
                                                                                Patients also able to access groups
                                                                                and activities run by day service and
                                                                                by ward staff at weekends and in
                                                                                the evening.
                                   Some areas of the ward, bathrooms          On-going rolling programme of
                                    and smoking room looking shabby             redecoration. The bathrooms and
                                    and in need of refurbishment.               kitchen area on the ward are
                                                                                amongst the next to be decorated.
                                   Difficulties with language and             No specific cash fund available for
                                    cultural issues as a result of the          foreign nationals although petty
                                    large number of foreign nationals on        cash is available to purchase
                                    the ward. Also resulting in bed             essentials on a case-by-case basis.
                                    blocking. Suggestion that a fund be
                                    set aside to enable staff to purchase
                                    essential items for such patients.
                                   Female patients being                      This was the exception to the rule
                                    accommodated in the male area.              and caused by a sudden influx of
                                                                                female patients. Additional female
                                                                                member of staff provided on every
                                                                                shift to supervise the area.
                                   Undeleted S17 leave forms in the           On-going training both corporate
                                    files. Continued training suggested.        and local available on S17 Leave.

  Site     Visit Date    Ward                MHAC Comments                              CNWL Response
Gordon     15.05.06     Belgrave      Concern expressed about the                Response in Progress
                                       inappropriate environment and
                                       location of the ward.
                                      Lack of adequate privacy due to
                                       clear panel in bedroom doors.
                                      Request for regular updates on the
                                       non-smoking policy at the Gordon
                                       and Trust wide.
                                      No entries by Statutory Consultees
                                       of the SOAD discussion.
                                      Lack of consistency by RMO in
                                       making SOAD entries.
                                      RMO not recording record of
                                       capacity assessment.
                                      Patient lost his spectacles
                                       Commissioner asked that staff look
                                       into this.

  Site     Visit Date    Ward                MHAC Comments                              CNWL Resposne
Paterson   19.05.06     Crichton      Requested information on patient           Response in progress
                        Browne         TS if placement funding fell through.
                                      Several issues on Patient TS, no
                                       Section 132 rights form found, no
                                       CPA documentation, old S17 leave
                                       form not crossed out and no record
                                       of consent discussion by the RMO.
                                      Requested information on any plans
                                       the Trust may have for developing a
                                       more integrated CPA process.
                                      Commissioner identified identical
                                       problems with Consent (S58) as
                                       highlighted by the Belgrave ward
                                       visit. Requested a generalised
                                       response covering both units.


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