- Independent mental health service
Moorlands Neurological Centre
All Inspections
During an assessment of the hospital overall
13 and 14 December 2022
During an inspection looking at part of the service
This was a focused follow-up inspection of Moorlands Neurological Centre, previously known as The Woodhouse Independent Hospital. At the time of our inspection, Moorlands Neurological Centre continued to provide a service to people with a learning disability or autism. We carried out this inspection to follow up on enforcement action we issued at our most recent inspection in February 2022, where we asked the provider to make significant improvement to its services.
In February 2022, our inspection of The Woodhouse Independent Hospital identified significant concerns that rated the service inadequate and applied Special Measures.
Since that inspection, the provider had commenced transformation of the hospital from one that provided a service to people with a learning disability or autism to one that provided a service to patients with an acquired brain injury. However, although the name of the hospital had changed, patients with an acquired brain injury had not yet been admitted.
Because this inspection focused only on the concerns raised at our previous inspection and the Warning Notice issued following it, we did not change our rating.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
The previous rating of inadequate remains because we did not have enough evidence to rerate the key questions of safe and well led. We found:
The provider continued to identify incidents where some staff did not always follow plans or use approved physical interventions with people who used the service during incidents or to manage behaviour that challenged.
The provider continued to identify incidents where some staff failed to identify and escalate abuse or improper treatment of people who used the service.
The provider remained challenged to ensure staff always accurately reported and recorded incidents that occurred in the service. It was not clear staff always used sharing of lessons learned following incidents to prevent similar incidents occurring again.
However:
The provider had implemented service transformation plans that meant people with a learning disability or autism would no longer be supported at the service. Feedback from commissioners on the implementation of the plan was positive.
We saw improvement in governance processes to ensure safety and quality in the service through monitoring of closed circuit television camera (CCTV) footage and incidents. This allowed managers to quickly identify and respond to concerns about the conduct or practice of staff with people who used the service.
The provider had taken action to support speaking up in the service. There was improvement in the number of staff speaking up with concerns related to safeguarding or culture in the service.
The experience of staff of leaders in the service continued to be positive. Plans to transform the service had been communicated well, staff felt well informed and supported during the process.
The provider had improved clinical areas in preparation for patients with an acquired brain injury. They had retained enough staff to safely meet the initial implementation of the new service model and supported staff to develop skills to work with the new patient group.
28 February 2022- 8 March 2022
During an inspection looking at part of the service
The Woodhouse Independent Hospital provides services for people with a learning disability or autism in a range of small, bespoke units and cottages. The service offers assessment, treatment and rehabilitation placements, individualised and intensive packages of care and step down to community-based services. The service specialises in providing care for autistic people and people with forensic histories.
The CQC expects health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
This inspection, which commenced on 28 February 2022, was an unannounced, focussed inspection to see what improvements the provider had made. Our inspection focussed on the concerns we raised to the provider following our previous inspection. We did not look at all of the key lines of enquiry.
Due to the seriousness of our concerns following our 1 March 2022 site visit, we wrote to the provider to inform them we were considering urgent enforcement action under Section 31 of the Health and Social Act 2008. The letter identified our significant concerns with staff conduct towards people using the service, inappropriate and disproportionate use of restraint and the investigation of incidents. We invited the provider to urgently complete and send an action plan detailing how they had already addressed or planned to immediately address our concerns. The provider responded with an action plan of sufficient assurance and we did not pursue urgent enforcement action. We returned to the hospital on 8 March 2022, and our findings provided us with further assurance to the immediate actions and the plan in place to protect people using the service from the risk of avoidable harm.
Despite improvements seen in some areas of the service since our previous inspection, we remain concerned about the way some staff have treated people who use the service and the robustness of governance arrangements in the service to always protect people. We have rated the service inadequate and placed it in special measures. Prior to the publication of this report, we issued the provider with a Warning Notice served under Section 29 of the Health and Social Care Act 2008. This notified them that they were failing to comply with Regulation 12 (1), Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and must demonstrate compliance by 11 November 2022. Details of the notice can be found at the end of the report.
Our rating of this service went down. We rated it as inadequate because:
- The service did not always provide safe care. Staff did not always follow plans or use approved physical intervention techniques with people who used the service. We saw staff tormenting, goading, lifting and dragging people when responding to incidents or behaviour that challenged.
- Staff did not always manage safety incidents well. Staff did not recognise all incidents that needed to be reported and some incidents continued to be reported inaccurately. Existing processes to use closed circuit television camera footage in the investigation of incidents had not been sufficiently robust to protect all people who used the service from avoidable harm.
- The provider’s action to assess for the presence of a closed culture had not identified similar concerns to those we observed during our inspection. Staff did not always treat people who used the service well during incidents and staff failed to identify or report practice or conduct of colleagues that was inappropriate or abusive.
- Not all governance processes appeared sufficiently robust or established to ensure safety and quality for all people who used the service and particularly those most vulnerable.
- The service continued to experience staffing challenges during the COVID-19 pandemic. Staff absences as a result of COVID-19 and the provider’s use of temporary staff during the pandemic had sometimes negatively impacted on the care and treatment of people who used the service.
- Environmental improvements to Moneystone had not sufficiently softened or reduced noise on the unit.
- There were concerns about excessive weight gain for some people who used the service. It was not always clear how effective the provider’s actions were to support people to remain healthy.
However,
- The provider’s response to the concerns raised to them following the inspection was immediate, robust and provided us with assurance risks to people who used the service would be mitigated.
- Many of areas of the service had improved to meet the requirement notices issued following our previous inspection. This included equipment to meet the sensory needs of people on Moneystone unit and improved medicines management practices.
- The provider had supported the hospital manager’s decisions to support safety and quality at the service as the COVID-19 pandemic progressed. There was additional leadership in the service. People who used the service and staff spoke positively about the visibility and approachability of the service managers.
- Many units provided people who used the service with their own apartment. Staff supported people to be independent and personalise their accommodation. The provider had invested in new furniture that was suitable for people who used the service and maintained communal and outdoor areas well.
As this service has been rated inadequate it will be placed into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
8 June - 21 June 2021
During an inspection looking at part of the service
The WoodHouse Independent Hospital provides services for people with a learning disability or autistic people in a range of small, bespoke units and cottages. The service offers assessment, treatment and rehabilitation placements, individualised and intensive packages of care and step down to community-based services. The service specialises in providing care for autistic people and people with forensic histories.
We most recently carried out a focused responsive inspection at The WoodHouse Independent Hospital in October 2020, but we did not rate the location at this inspection. This meant we did not gather enough information across the whole service to re-rate it due to the specific focus of our inspection.
Following the inspection in October 2020, we issued an urgent Notice of Decision in relation to Regulation 12 regarding infection prevention control measures and placed conditions on the provider’s registration. These conditions were removed in January 2021 after the provider applied to have the conditions removed and supplied evidence to us that infection prevention control practices had improved.
This inspection was carried out to follow up on the concerns identified during our previous inspection as well as respond to new information of concern received about the safety and quality of the services.
We undertook an unannounced focussed inspection of all key questions:
Are services safe?
Are services effective?
Are services caring?
Are services responsive?
Are services well-led?
We visited the location on 8 June 2021 during the day and night shift and again on 9 June 2021 during the day shift.
We did not look at all key lines of enquiry during this inspection. However, the information that we gathered, the significance of the concerns and the impact on people using the service provided enough information to make a judgement about the quality of the care and enabled us to re-rate all key questions.
Our rating of this location stayed the same. We rated it as requires improvement because:
- People’s care and support was not always provided in a well-furnished and well-maintained environment which did not always meet people’s sensory needs.
- Not all staff understood how to protect people from abuse. Staff had training on how to recognise and report abuse but did not always know how to apply it
- The service did not always have sufficient, appropriately skilled staff to meet people’s needs and keep them safe. There was a high use of agency staff who did not always know the people they were supporting. There were not always enough nurses working across the site to support all eight units. Staff continued to not receive their break.
- Staff continued to not always follow systems and processes to safely prescribe, administer, record and store medicines.
- Staff did not always report incidents or carry out body maps after incidents of physical intervention.
- Not all staff working on the female unit Hawksmoor were provided with any additional specific training to support females.
- Maintenance faults were not always reported appropriately by staff and therefore were not rectified in a timely manner.
- People did not always receive kind and compassionate care from staff and they did not always understand each person’s individual needs.
- Staff did not always receive regular supervision and the service had low rates of supervision.
- Staff did not always maintain contact and share information with those involved in supporting people, as appropriate. Relatives and carers did not always receive timely information and did not feel actively involved in planning their relative’s care.
- There was not a robust system in place to ensure that staff who were working during the night shift were appropriately undertaking their roles.
- There were not always enough vehicles or drivers to support section 17 leave.
- There continued to be a lack of leadership at middle management level. Staff did not have confidence in nurse managers and did not find them approachable. Staff did not feel able to raise concerns without fear of retribution. The process in place for raising concerns was not always adhered to by managers.
However:
- People had their communication needs met and information was shared in a way that could be understood.
- People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
- Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
- People were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
- Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.People were in hospital to receive active, goal-oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support in place they went home.
- People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.
- People were supported to be independent and had control over their own lives.
We expect Health and Social Care providers to guarantee people with a learning disability and autistic people the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people. The service could not show how they met some of the principles of right support, right care, right culture.
It was clear that there was a need for the service as agreed by commissioners. People were able to access the community for various activities and the service works towards policies and procedures being in line with best practice. Care that was provided to people was person-centred.
However, the setting and design of the service did not always meet people’s sensory needs. For example, we did not find Moneystone unit to be autism friendly. We also found with staff morale, staff cliques and lack of faith in managers, the culture was not always the right culture for people using the service.
We found a mixed culture at the service. We saw evidence that most recovery workers ensured people received person-centred care. However, we also heard about and saw evidence of some people being exposed to inappropriate practices and not always being protected from harm.
There was a lack of leadership at a nurse manager level. Staff were reluctant to raise concerns and when they did, managers failed to respond or act on these concerns. There were some poor relationships within staff groups and it was reported there were cliques among some staff across the service. This led to some staff reporting feeling uncomfortable working on certain units.
08 October 2020, 14 October 2020
During an inspection looking at part of the service
The WoodHouse Independent Hospital provides services for patients with a learning disability or autism in a range of small, bespoke units and cottages. The service offers assessment, treatment and rehabilitation placements, individualised and intensive packages of care and step down to community-based services. The service is specialist in providing care for individuals with autism and forensic histories.
We inspected the hospital because we received information of concern about the safety and quality of the services. We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection. Therefore the inspection focused on specific areas of the following key questions:
- Are services safe?
- Are services well-led?
We carried out an unannounced responsive inspection and visited the location on 8 October 2020 during the night shift and again on 14 October during the day shift.
We focused on specific areas of the safe and well-led key questions. We did not rate the service at this inspection as we were looking at specific concerns. This meant that not all areas within each key question were reviewed or reported upon and therefore we did not gather enough information across the whole service to re-rate it.
We identified the following areas of concern:
- Staff did not always follow infection control policies and procedures and the units were not always clean. The provider did not act in a timely manner to respond to concerns raised on our first visit to minimise the potential risk posed to patients through a lack of staff adherence to these measures.
- The units did not always have enough nursing staff who knew the patients to keep them safe from avoidable harm. Staff told us that patients were not always able to access time outside of the unit to access fresh air and staff were not always able to take their break.
- Staff did not always follow the provider’s policy on carrying out observations.
- Staff told us that they did not always feel valued, respected and supported. They did not always feel able to raise concerns without fear of retribution. Staff told us managers were not always visible or approachable.
- Governance processes did not always work effectively at unit level. There were not robust processes in place to provide assurances of the quality of care that patients receive.
However, we also found:
- Staff followed good practice with respect to safeguarding and minimised the use of restrictive practices. The service managed patient safety incidents well and recognised and reported incidents appropriately.
- Leaders had the knowledge and experience to perform their roles and had a good understanding of the services they managed.
We will add full information about our regulatory response to the concerns we have described to a final version of this report, which we will publish in due course.
18th - 20th February 2020
During a routine inspection
The WoodHouse provides services for patients with a learning disability or autism in a range of small, bespoke units and cottages. The service offers assessment, treatment and rehabilitation placements, individualised and intensive packages of care and step down to community-based services. The service is specialist in providing care for individuals with autism and forensic histories.
Following our inspection in June 2019 we placed the service in special measure because it did not have enough suitably qualified and skilled staff to deliver safe care to patients with learning disabilities and autism.
On this inspection we found that the provider had made a number of improvements identified as being required at the last inspection but found further areas that needed improvement. However, we have judged that enough improvement has been made to remove the provider from special measures.to remove the provider from special measures.
Our rating of this service improved. We rated it as requires improvement because:
- Not all units were clean or well-maintained to uphold patients dignity. Staff did not have knowledge and understanding in the operation of anti-barricade doors and may not be able to gain access to a patient who is in need or at risk quickly to intervene.
- Although the provider had changed its approach to care planning since the last inspection, staff did not always develop care plans for all patients that were recovery-orientated or person centred, and they did not clearly identify patients’ needs and goals.
- Staff did not always assess and record capacity clearly for patients with specific physical healthcare needs, who might have impaired mental capacity to make decisions. Consent to treatment for physical healthcare needs was not always assessed and recorded.
- Staff did not actively involve patients and families in decisions about their care. There was no patient perspective in care plans as they were not written in collaboration with patients.
- Some of the governance processes did not ensure that units ran smoothly. The service had begun to implement a local audit schedule; however, it was not always clear that actions resulting from audits were addressed. Information in paper-based systems was not always accurate or up to date and did not reflect the information stored on the electronic patient information system.
However:
- The units had enough nurses and doctors. Staffing levels and use of agency staff had improved since the last inspection. Staff assessed and managed risk well, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
- The service provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability (and/or autism) and in line with national guidance about best practice. Staff had begun to engage in clinical audit to evaluate the quality of care provided.
- The unit teams included or had access to the full range of specialists required to meet the needs of patients on the units. Managers ensured that these staff received training, supervision and appraisal. The unit staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
- Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
- Staff managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
18 – 20 June 2019
During a routine inspection
We rated The Woodhouse Independent Hospital as inadequate because:
- The hospital was not adequately staffed. Nearly 90% of the establishment ward staff posts were unqualified support workers and 40% of posts for both nurses and support workers were vacant. As a result, unqualified agency staff covered a high number of shifts. This included most of the night shifts. Some of the agency staff were new to the hospital and did not know the patients. This meant that the care plans and positive behaviour support plans developed by the specialist staff were not always enacted by the ward-based staff – some of whom told us that they had not read the plans. Also, the staffing situation meant that a qualified nurse was not always present in communal areas of the ward, that staff were often unable to take rest breaks or regular breaks from enhanced observations, that escorted leave was often cancelled for patients on general observations and that patients did not have regular one-to-one time with their named nurse.
- Managers did not provide staff with the induction, training, supervision or appraisal that would have mitigated the staff’s lack of qualifications and specialist skills required to provide high quality care to people with such complex needs.
- The service was not well led at ward level and there was a lack of resource at all levels of leadership. The governance processes did not operate effectively at ward level meaning that performance and risk were not managed well. Clinical and internal audit processes did not have a positive impact on quality governance. There was no structured induction programme for agency staff. Staff were not supported through appraisals and regular supervision to enable them to carry out the duties they were employed to perform. There were no regular team meetings for staff to discuss clinical concerns and learning as a team with managers.
- Staff did not always follow systems and processes to safely store and manage medicines. Learning from incidents was not discussed with staff. Managers did not always debrief and support staff after serious incidents.
- The ligature risk assessments lacked clear actions on how the risk was managed. There was no emergency drug (Adrenaline) available to treat anaphylaxis. The checks were not always reliable and valid.
- Staff did not monitor the physical health of patients consistently. Care plans did not always reflect the assessed needs of patients. They were not always personalised, holistic and recovery-oriented nor always updated in a timely manner. Staff did not participate in clinical audits, benchmarking and quality improvement initiatives.
- Staff did not always assess and record capacity to consent clearly where patients might have impaired mental capacity. Staff did not know their identified lead for the Mental Capacity Act.
- There was no sensory room within the hospital to meet the needs of patients who would benefit. Quiet areas on some wards were not available to allow patients an opportunity to avoid noise and disruption. Managers did not regularly review the mix of patients on the wards to ensure the environment was comfortable for all patients.
- The provider had not carried out an autism friendly assessment to ensure that the environment was suitable for patients with autism. The service did not ensure that the needs of patients with specific communication needs were met.
However:
- Staff understood how to safeguard patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
- Staff regularly reviewed the effects of medications on each patient’s physical health. They knew about and worked towards achieving the aims of the STOMP programme (stop over-medicating people with learning disabilities).
- We observed staff treating patients with compassion and kindness. They respected patients’ privacy and dignity. The multidisciplinary team involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided.
- Staff planned and managed discharge well. Staff helped patients with advocacy, cultural and spiritual support.
7 November 2017
During an inspection looking at part of the service
We rated The Woodhouse Independent Hospital as good for the Safe domain because:
- During the most recent inspection, we found that the service had addressed the issues that led us to rate the Safe domain as requires improvement following the January 2017 inspection.
- We found that when staff gave oral medication for the purposes of rapid tranquillisation, they completed the necessary physical observations. The provider had removed restrictions that meant that it no longer had a patient living in long-term segregation. The provider had a floating nurse to support the wards for people with learning disabilities or autism, in addition to the staffing establishment for each of the wards. Moneystone ward had sufficient staffing levels to meet patients’ needs.
- We found that the provider had allocated a lead nurse for infection prevention and control to the wards for people with learning disability or autism. Staff completed checks on emergency bags on all the wards. Staff completed records to show they had cleaned portable clinical equipment on all the wards. Staff had de-cluttered and tidied the storeroom, and cleaned, redecorated and re-floored the sluice room on Moneystone ward.
- The provider offered overtime to its staff and had a bank staff system to help fill shifts. The provider used agency staff frequently, and wherever possible, they tried to use staff who were familiar with the service. Most staff in the core service had received training in autism.
However:
- Staff did not always record the time of the physical observations they completed after they gave oral rapid tranquillisation.
- There were different processes for recording physical observations on the wards.
- The provider’s rapid tranquillisation policy lacked guidance on monitoring physical observations after oral rapid tranquillisation.
17-19 January 2017
During a routine inspection
We rated The Woodhouse Independent Hospital as good overall because:
- During this inspection, we found that the provider had addressed most of the issues that made us rate forensic inpatients/secure wards and wards for people with learning disabilities or autism as requires improvement for the safe, effective and well led domains in our last inspection in October 2015.
- All wards had access to emergency equipment such as automated external defibrillators and oxygen cylinders. Staff practised good infection control and food hygiene.
- Wards did not have nurse call systems but the provider had a specific risk assessment that identified the risks and how they mitigated them. This was mainly through designated support levels for each patient, observation and supervised access to high-risk areas.
- Staff received training in, and had a good understanding of, the revised Mental Health Act Code of Practice and the Mental Capacity Act. The hospital had effective and robust arrangements to monitor adherence to the Mental Health Act and Mental Capacity Act.
- The provider had improved its focus on autism and set clear aims and objectives for the service. Wards had autism-friendly features, staff assessed and met patients’ individual communication needs, and staff had access to specialist training.
- The provider had developed two clear service pathways - learning disability (incorporating the forensic inpatient/secure ward service), and autism. It had strengthened its leadership with designated operational managers and clinical leads for each service, and recruited a consultant psychiatrist with specialist skills for the autism service.
- The provider had improved its governance systems and processes for monitoring all aspects of care. For example, the provider had robust incident monitoring processes and held regular meetings to review restrictive practices.
However:
- When staff on Moneystone and Highcroft wards gave oral medication for the purposes of rapid tranquillisation, they did not always complete the necessary physical observations.
- The hospital did not have an active clinical lead role (for example, a named nurse) allocated to infection prevention and control.
- There were short periods when there was no qualified nurse present on Moneystone ward, and there were occasions when staffing levels were insufficient to meet patients’ observation requirements.
- We found gaps in the checks on the emergency bags on Moneystone and Highcroft wards.
- There were no records that confirmed the cleaning of portable clinical equipment on Moneystone and Highcroft wards.
- There were inconsistencies in the completion of forms used for recording observations of the patient in long-term segregation.
20 - 21 October 2015
During a routine inspection
We rated Woodhouse hospital as requires improvement because:
- Staff did not regularly check medical emergency equipment for Lockwood and Highcroft to ensure it was in good working order when needed. Moneystone did not have automated external defibrillators and oxygen.
- Staff in Moneystone and Whiston did not practice good infection control procedures and food hygiene to protect patients and staff against the risks of infection.
- The wards were not fitted with nurse call systems in bedrooms and bathrooms for patients to alert staff to any emergency.
- Staffing levels fell below the required levels particularly at weekends and nights. There was a high rate of staff turnover and high use of agency. Activities and community leave were cancelled because there were not enough staff on duty.
- On call doctor covered a large geographical area including all the Lighthouse hospitals. This meant that the doctor would not always be able to get on site on time to support staff during an emergency when needed.
- There was no evidence that the safeguarding team were alerted to the patients in long-term segregation. Patients in long-term segregation did not have independent reviews taking place.
- Although staff had received training in autism, they demonstrated a limited understanding of caring for patients with autism. Staff did not recognise the need for a consistent structured routine to follow on a daily basis with individual patients.
- Staff had not received training on the revised Mental Health Act Code of Practice.
- Staff in wards for people with autism demonstrated a poor understanding of the Mental Capacity Act and found it difficult to demonstrate how the five statutory principles applied to practice.
- All staff should be receiving supervision in line with the provider’s policy and good practice. The minimum standard for management supervision was one hour once every three months. 25% of permanent staff had not received supervision in the three months prior to our inspection on 21st October. There was system to monitor the additional requirement for clinical staff to receive clinical supervision.
- Staff did not always give patients copies of their care plans and record their views in care plans. Staff did not record patients’ advance decisions. These are decisions made by patients about their wishes for future care.
- The hospital did not have an examination couch to carry out physical examination of patients. Moneystone and Highcroft wards did not have sensory rooms.
- The units did not offer enough meaningful and purposeful activities that promoted independent living skills. The activities appeared to focus more on leisure. Patients, relatives and staff told us that activities were limited on weekends and evenings.
- Relevant information for patients on subjects such as advocacy services, their rights and complaints was not available in easy-read versions.
- Staff from wards for people with autism did not demonstrate a good understanding of their team objectives and reported receiving mixed messages from senior management about the aims and objectives of the service.
- Staff morale was low particularly on the wards for people with autism where staff felt that senior management did not listen to their concerns. Staff told us that opportunities for clinical and professional development courses were limited.
- The governance processes to manage quality and safety did not effectively monitor and address these areas.
- The occupational therapy assistants felt they were working without clear clinical leadership and support in the absence of a qualified occupational therapist.
However:
- The wards were clean and staff had carried out environmental risk assessments to identify potential ligature risks that might put patients at risk. They had put mitigating plans in place to manage them safely.
- All units carried out comprehensive assessments of need on admission. These included detailed risk assessments and risk management plans that were updated regularly after every incident. These care plans followed a positive behaviour support approach.
- Staff were trained in safeguarding and demonstrated a good understanding of how to identify and report abuse. Staff knew how to recognise and report incidents through the reporting system. Learning from incidents was shared with staff.
- In the clinical records we checked, we saw details of regular physical health checks.
- Patients could access psychological therapies as part of their treatment. For example, anxiety management and the adapted sex offender’s treatment programme recommended by the National Institute for Health and Care Excellence.
- Staff treated patients with respect and dignity. They were polite, kind and willing to help. Patients and families were happy with the support they received from the staff and felt that they got the help they needed.
- Staff involved patients in their clinical reviews and care planning and encouraged them to involve relatives and friends if they wished. Patients and their families told us that they could access advocacy services when needed.
- Families and carers told us that they could raise any concerns and complaints freely.
15, 17 April and 8 May 2013
During a routine inspection
During this inspection, we spoke with six patients. All the patients were happy with their care. Several patients told us that their families were also happy with their care. One patient told us, 'My mum is happy with the care I receive and visits every week.' The patients were happy with the staff looking after them. One person told us, 'I can trust some of the staff with my problems and they will try to help me.'
We found detailed care plans and risk assessments were in place and up to date and that safe practice in the handling of medicines was being followed. We found that some records were not always fully completed or reliable to support decision making and the review of people's needs.
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The hospital kept the overall number of staff required under review to ensure that patients' needs were met. There were effective staff recruitment and selection processes in place to ensure that staff were suitable to be working in the hospital.
The arrangements in place did not provide a fully effective system to manage the risks to the quality and safety of care at the hospital.
24 April 2012
During an inspection looking at part of the service
When we visited last time we noted that some people were not involved in planning their own care. On this occasion we saw during this visit that the service had started to make some progress in achieving this although further work was needed. We identified that the service had started to work with people to look at their needs and to identify their preferences and important things in their lives.
On our last visit we identified improvements that the service could make in how it gave staff information about plans of restraints and restrictions. We saw that the service had made progress in this area. We had also identified that some people were not being supported sufficiently with undertaking activities. Most people we spoke with on this visit told us that they took part in activities although in some instances the records did not fully support this.
We and the Mental Health Act Commissioner (MHAC) spoke to some people about their care. Some people were not able to tell us about their care. People we spoke with told us that they were satisfied with the support they received. We saw that in one of the units we visited that patient involvement meetings were held where people could raise issues and any concerns. On another unit we were told that staff met with people individually to gain their views but the records did not fully show that these were always held. An advocate visited all the units to support people to express their views.
We saw evidence that the service had started to develop information in a more user friendly manner. A part time speech and language therapist had been apppointed and was working with people on communication passports and was starting to train staff in developing a range of key signs to develop more effective communication.
We identified areas for improvement in the way some medication was being stored and administered.
We saw that the service had introduced additional systems to keep people safe and to respond to any incidents of concern. We saw that staff were trained in recognising and reporting safeguarding issues and the service had developed an easy to read leaflet about abuse, although this had not yet been introduced. We felt that staff needed to be more aware of issues relating to the Mental Capacity Act 2005 and the manager confirmed this would be included in staff's annual training. We saw that some of the annual updates on physical intervention were overdue.
The service had systems in place to review and monitor the care people received.
20 October and 14 November 2011
During a themed inspection looking at Learning Disability Services
Patients who could verbally communicate told us that they were involved in their care plans, so they had a say in how they were supported. Patients who have non verbal communication skills were not involved and not supported to be. Some relatives felt that they were not as involved as much as they would like to be in their relatives care plans. This means that if the patient is unable to communicate their needs and preferences they may not be supported in the way they want.
We saw that a range of educational and social activities were provided and patients told us they were supported to take part in the activities they were interested in.
Patients said they have access to advocates who help them to have a say in how they are supported and ensure their rights are upheld.
Mental Health Act Commissioner reports
Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.
Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.