Focussed Visit summary: Visits to people in mental health continuing care and rehabilitation facilities
Number of visits 6
Number of recommendations 24
Recurring themes and areas for improvement
1.Environment
Several of the facilities we visited were in the process of planned closure and relocation. We were concerned in some instances about that the lack of ongoing maintenance and refurbishment in the period before closure. We made a number of recommendations aimed at improving these care environments to meet people's right to privacy and dignity. These included:
- Replacement of worn furniture
- Timing of unit refurbishment to minimise disruption to patients
- Personalisation of bedrooms
Example of improvements following our visit:
Our recommendation where we had concerns that patient care might be adversely affected by renovations:
Timing of the unit refurbishment should be carefully considered to minimise disruption to patients' care and treatment
The hospital's response:
The residing patients moved to new facilities allowing this area to have the relevant planned refurbishment take place prior to the transfer of a new patient group. A small working group was developed and an action plan implemented to upgrade the garden area with new furnishings, patio and flower beds. Patients report that they are pleased with their new facilities and the refurbishment did not affect their care and treatment
2. Care Plans
Patients in continuing care/rehab settings should have the opportunity to maintain or regain living skills. We wanted to ensure that care plans were supporting this move towards recovery. Principles underpinning mental health legislation include ensuring benefit, taking account of peoples' past and present wishes and considering the full range of options for care. We visited wards where care plans were standardised, often limited in scope and showed little evidence of patient involvement.In these instances, we made recommendations which addressed:
- Lack of individualised assessment of needs
- Limited involvement of patients in developing care plans
- Narrow range of therapeutic options
Example of improvements following our visit:
Our recommendation where we had concerns about the quality of care plans :
Care plans should be based on a holistic assessment of individual needs and address all aspects of the individual's care and treatment. Care plans should contain an individual activity programme and a record of the outcome of interventions including social and recreational activities. Care plans should evidence patient involvement in their development.
The hospital's response:
The Practice Development Team have completed training with the staff on Scottish Recovery Indicators and utilising the principles of the 10 Essential Shared Capabilities with the implementation of the generic ACP due in May 2011. Introduction of Releasing Time to Care with planned implementation programme to commence May 2011. All care plans have been reviewed and updated with patients/carers/family/advocacy involvement.
3. Activities
We looked for evidence of an 'activity culture' which would reflect individuals' personal choices, preferences and abilities and promote physical health and mental wellbeing.We made recommendations about:
- The need for individualised activity programmes
- Lack of OT provision
- Recording the outcomes of social and recreational activities to demonstrate the benefit to the individual
Example of improvements following our visit:
Our recommendation where we were concerned about the apparent lack of meaningful activities for patients on a 'slow stream' rehab ward suffering from 'pre-closure blight':
Managers and staff should establish a programme of meaningful activities to meet the individual needs and preferences of all the residents of the ward and there should be user involvement in this process.
The hospital's response:
Recreational department will remain on the site until closure. A timetable of recreational activities displayed on all notice boards in the ward. Recreational activity is discussed at weekly patient meetings. Recreational staff are rostered daily to support the provision of both social and recreational activity within and outwith the ward.
