Membership review for Fairview Hospital

This membership review is intended to reflect the experiences of the visitor who might be looking for a placement.  The review is subjective, consistent and impartial, representing the impressions of our team member on the day of the visit.  It is a snapshot view only.

The contents of this review are intended to cover some of the subjects and issues which an individual, their relatives or their placement officer might ask.

This review has been published with the written agreement of the home owner, or an authorised representative of the company.

“Great attention appeared to have been given to communication between disciplines for the benefit of the patients.”

Summary of Findings

Cambian Fairview is a hospital a short distance from the centre of Colchester. It presented as a modern, well-equipped service with an extensive team of knowledgeable staff including a large clinical team.

I was greeted by Darsana Karki, Head of Service, and Eibhlin Henry also Head of Service and shown into a small meeting room adorned with a large mural on one wall and comfortable seating and coffee tables.  I was offered coffee and later given lunch. Most of my time was spent with Eibhlin who demonstrated a good understanding of her patients and spoke of them with respect and affection.  

Introduction

Fairview was serving people with a learning disability, some of whom were on the autism spectrum.  It was a 67 bedded unit divided into 7 smaller units.  Elm Court was for people with autism who had a high level of learning disability; Redwood Court was for people who have high functioning ASC. Oak and Beech Courts were for patients with a learning disability but no autism; Cherry Court was a female rehabilitation unit and Sycamore and Laurel Courts were male rehabilitation units.

Shortly prior to my visit, the service had a CQC inspection which graded them as uncompliant. I was told that this did not relate to the autism section of the service which was compliant and all issues had been addressed. Staff were keen for the CQC inspectors to return to restore their service to compliant.

First Impressions

I entered the grounds of this service through large open gates and could immediately see the reception area.  I was buzzed in through the glass doors and invited to sign in and take a seat whilst the person I was due to meet was located.  I was offered a cup of coffee whilst I waited.   Several staff members accompanied by patients wandered in and out whilst I was there on their way to various activities.  The conversations taking place were respectful and friendly.  The reception area was clean, modern and had very comfortable seating and a selection of large plants and pictures to make the place look homely.

The Environment (External)

The grounds were surrounded by a tall wrought iron fence which was well maintained and attractive; in some places they were disguised by shrubs.

The buildings were clad with wood boarding and stained a very dark brown. They looked well maintained and very attractive.

There was parking for the service’s transport just in front of the reception area and a further car park to the right hand side of the building. 

The service also had small farm with a selection of small animals, cared for by the service users. There was also a gym.

The Environment Internal

Off the reception area was a selection of offices and meeting rooms.  These were modern, attractively furnished and some walls were adorned with large murals of rural scenes.

I was shown around one of the units by the speech and language therapist and occupational therapist.  At one point one of the young people joined us and was keen to show me his room and talk to me about his time at Fairview.  He appeared very happy and had enjoyed his stay but was now looking forward to moving on once a suitable place was found for him.

The rooms were of a good size and appeared well maintained and clean with comfortable furnishings.  I was told that the patients could choose the colour of their rooms and bring in their own furniture if they preferred.  Programmes of activity, notices and instructions were all written in symbol form and displayed on the walls. Also displayed were “happy and sad” faces with stickers so the patients could describe the mood they were in.

A short distance from Fairview there was a building known as the Joy Clare which is part of the Fairview service which the patients attend to participate in various therapies such as arts and crafts, cooking, gardening and pet therapy.

There was also a gym, beauty salon and IT room on site.

The Wider Environment

Cambian Fairview is a short car ride from the centre of Colchester and has good public transport links into the town and to London.  

Colchester is steeped in history being the oldest recorded town in Britain.  It has a zoo and a castle amongst its attractions.  Beautiful countryside is a short distance away. Patients are encouraged to access the wider community as much as possible and are given mobile phones if out on their own so that they can call for assistance if necessary.

Understanding Autism

Referrals came from anywhere in the country and could be planned or emergency. Commissioning Managers and nurses assessed the individual and presented the information to the multi-disciplinary team (MDT).  This consisted of 3 consultant psychiatrists, a psychologist, therapy coordinators, speech and language and occupational therapists and nursing staff.

The mental capacity of the patient was assessed and where possible, admission planned.  Photos of staff and environment sent, visits planned and as much key information gathered to ensure a smooth transition. A “day in the life” programme is given to the patient so that he or she had an understanding of how the hospital day functioned.

The care plans were compiled within the first 24 hours and reviewed after 6 weeks and thereafter 4 monthly. Each patient was seen monthly by the MDT.  Patients had 1:1 meetings with their keyworker on a weekly basis.

Programmes of activities were all compiled in an easy-to-read format to suit the individual and each had a communication and sensory profile. Social stories were used for some patients.

Patients were encouraged to learn as many independence skills as possible with the aim to move them into residential or supported living as soon as possible. The length of stay at the hospital was very varied.  Eibhlin told me of one patient who had taken 3 years to develop the confidence to come out of his room to go swimming at the local baths.  Small steps were taken every day until the goal had been achieved.  It was a very emotional and positive moment for the team.

Health and Wellbeing

Each patient was registered with the local GP practice and the doctor visited the service weekly.  Routine blood tests were carried out six monthly and ECGs annually.

Medication was administered by qualified nurses only and stored within regulation guidelines.

Menus were well balanced and nutritious and came from a central kitchen. Everyone had a choice of two for each meal and choices were presented in an easy-to-read format. Community meetings were held weekly attended by the chefs to discuss menus.

Cultural dietary needs were catered for.

In addition, food preparation was included as part of the development of the individual’s life skills where appropriate in which menus were planned, purchases made within a budget and food cooked.

Individuals in the Hospital

As previously mentioned patients at Fairview had a wide range of learning disability and programmes varied widely.

I was told that patients with Asperger’s syndrome would be supported to apply for paid employment if appropriate and some already attended voluntary work within the local community.

Staffing

Staff were recruited through adverts in professional papers, agencies, job centre and websites.

The interview process included patients on the panel. Disclosure and Barring checks (DBS) were completed and two references obtained before induction training commences.  Nurses were expected to write a care plan as part of the interview process.

Induction training included the standard subjects- fire safety, ABC forms, first aid, self -harming, health and safety, mental capacity and DoLs, communication.   Much of this was done through an on-line training service. Also included was Management of Violence and Aggression, which studied de-escalation techniques.

On-going training for nurses came in the form of completing an Open University course on Understanding Autism in the Workplace.

Supervisions took place on a monthly basis to provide staff opportunity to discuss issues of concern or career development.

A system was in place for staff to de-brief following an episode of aggression and they had the opportunity to withdraw from working with that individual for a while if it would help de-escalate a heated situation.

All ancillary staff also receive induction training.

Management of the Hospital

Fairview was managed by a strong clinical team and each unit had two senior staff nurses, four staff nurses, two senior support workers.  The number of support workers varied according to the staffing needs of the patients on the wards which were determined when the patient was assessed prior to admission.

The aim of each care plan was to reduce anxieties, stabilise patients in crisis and to promote life and independence skills as much as possible.

All activities were risk assessed and reviewed three monthly. Risk assessments also took place daily at staff handover.

To develop skills patients had an incentive programme which could be monetary or the use of rewards that were particularly relevant to the individual.

Of the 67 patients in the hospital approximately three quarters of them have had sections placed upon them under the Mental Health Act.  The aim is to remove these at the earliest opportunity.

Conclusion

I was particularly impressed by the examples of problem solving and patient progress that I was told about whilst I was at Cambian Fairview. Great attention appeared to be given to communication between disciplines for the benefit of the patients.

I would like to thank all of the staff for giving me their time and sharing their enthusiasm. My particular thanks go to Eibhlin and Dr Asiain who also spent time talking to me about the service and I wish them all well for the future.

 

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Visiting Officer - Pat Clendining, Head of Assessments
Living Autism