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Turning Point - Douglas House Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 4 August 2016

We rated Turning Point - Douglas House as outstanding because:

  • There were strong, person centred clinical leadership and governance arrangements, led by a well-respected registered manager. The manager clearly articulated the changes they had made to the hospital through listening to staff, patients and other stakeholders. This was complemented by a comprehensive range of audits which were fully completed to continuously drive improvement. The manager had clearly articulated positive changes following audit.
  • Patients and staff worked in true partnership as equal partners with a focus on recovery principles and shared decision making. Managers were looking to consolidate this through adopting the ‘implementing recovery through organisational change’ programme. The service involved patients in a range of ways and at all levels from involvement in their own individual care goals through to involvement in the hospital through to commenting on Turning Point’s national policy and campaigning work. This was exemplified by the manager who encouraged patient representatives to be fully involved in the presentation made to the CQC inspection team.

We also saw:

  • Staff carried out thorough risk assessments on patients to ensure they could be cared for in a rehabilitation environment. The hospital manager took immediate and significant action to address the washing arrangements in one bedroom so that it fully complied with same sex guidance. The hospital had minimal incidents but when these occurred staff took appropriate action to address them and learn lessons.
  • The hospital was recovery focused with care and support plans developed from the mental health recovery star tool. Patients received multidisciplinary input from a range of staff which included an occupational therapist, an arts therapist and assistant psychologist. Staff provided enthusiastic and individualised support to patients over daily tasks such as planning and shopping for meals, cooking and tidying. There were good systems in place to support adherence to the Mental Health Act (MHA).The MHA co-ordinator attended ward rounds on a weekly basis to promote adherence to the MHA.
  • Staff engaged with the local city-wide review team to discuss and co-ordinate the admission of all patients into rehabilitation beds across Manchester. The hospital started planning for patient discharge from when patients were first admitted. There was a small outreach team to work with patients on discharge if they needed ongoing proactive support. There had been no complaints at Douglas House for the last 12 months.

However we also found that:

  • The medical input to patients provided by the local mental health trust was not covered by a written service level agreement that clearly outlined the rights and responsibilities of each party and the appropriate local escalation and resolution if any matters of concern were raised by either party.
Inspection areas

Safe

Good

Updated 4 August 2016

W

e rated safe as good because:

  • There were appropriate admission assessments in place to ensure that patients could be cared for safely in a rehabilitation environment.
  • Whilst there were ligature risks these were mitigated by appropriate assessment, individualised risk management and therapeutic engagement of patients.
  • The hospital mostly complied with the Department of Health required guidance on same sex accommodation and took immediate and significant action to address the washing arrangements in one bedroom so that it fully complied with same sex guidance.
  • There were enough staff to ensure the safety of patients at all times.
  • Staff carried out thorough ongoing risk assessments on patients.
  • There were a range of well-completed health and safety, medication and maintenance audits in place.
  • Nursing staff worked within appropriate medicine management arrangements.
  • Staff understood safeguarding procedures and took action to safeguard vulnerable patients.
  • The hospital had minimal incidents but when these occurred they told us about them and took appropriate action to address them and learnt lessons.

Effective

Good

Updated 4 August 2016

We rated effective as good because:

  • The hospital was recovery focused.
  • Care and support plans were developed from a recognised recovery based assessment tool (the mental health recovery star tool).
  • Patients received medical and clinical interventions to minimise symptoms of their mental health through both medication and psychological interventions.
  • Patients received input from a multidisciplinary team which included an occupational therapist, an arts therapist and assistant psychologist.
  • Staff providing enthusiastic and individualised support to patients over daily tasks such as planning and shopping for meals, cooking and tidying.
  • Patients received support to ensure they received appropriate physical and dental health care.
  • Managers carried out a number of audits including medication, multidisciplinary team records, patient involvement, risk management and infection control.
  • There were good systems in place to support adherence to the Mental Health Act (MHA).The MHA manager attended ward rounds on a weekly basis to promote adherence to the MHA.
  • Where mental capacity assessments were carried out, these were decision specific and followed the principles and stages set out in the Mental Capacity Act.

Caring

Outstanding

Updated 4 August 2016

We rated caring as outstanding because:

  • Patients were universally positive about the staff in the hospital providing high quality care and support.
  • We observed staff providing positive and enthusiastic support to patients including a very positive group meeting on healthy eating.
  • Carers we spoke with were also very positive about the support their loved ones had received.
  • Patients were seen as active partners and were encouraged to be involved in many decisions. For example, patients were actively involved in the presentation that the managers of the hospital gave to us.
  • Patients were encouraged to be involved in their own recovery, the running of the hospital, regional meetings and commenting on national policy through the national organisation.
  • Patients had access to advocacy input on a telephone referral basis; which promoted patients to access advocacy themselves.

Responsive

Good

Updated 4 August 2016

We rated responsive as good because:

  • Douglas House staff engaged with the city-wide review team to discuss and co-ordinate the admission of all patients into rehabilitation beds across Manchester
  • Patients who had recently been admitted to Douglas House had received a gradual process of visits, overnight stays and extended leave before being transferred fully.
  • The hospital started planning for patient discharge from when patients were first admitted.
  • There was a small outreach team to work with patients on discharge if they needed ongoing proactive support.
  • The hospital had a homely feel.
  • The hospital provided vegetarian options and Halal food to meet the needs of current patients.
  • There had been no complaints at Douglas House for the last 12 months.

Well-led

Outstanding

Updated 4 August 2016

We rated caring as outstanding because:

  • Patients were universally positive about the staff in the hospital providing high quality care and support.
  • We observed staff providing positive and enthusiastic support to patients including a very positive group meeting on healthy eating.
  • Carers we spoke with were also very positive about the support their loved ones had received.
  • Patients were seen as active partners and were encouraged to be involved in many decisions. For example, patients were actively involved in the presentation that the managers of the hospital gave to us.
  • Patients were encouraged to be involved in their own recovery, the running of the hospital, regional meetings and commenting on national policy through the national organisation.
  • Patients had access to advocacy input on a telephone referral basis; which promoted patients to access advocacy themselves.

Are services responsive to people’s needs?

We rated responsive as good because:

  • Douglas House staff engaged with the city-wide review team to discuss and co-ordinate the admission of all patients into rehabilitation beds across Manchester
  • Patients who had recently been admitted to Douglas House had received a gradual process of visits, overnight stays and extended leave before being transferred fully.
  • The hospital started planning for patient discharge from when patients were first admitted.
  • There was a small outreach team to work with patients on discharge if they needed ongoing proactive support.
  • The hospital had a homely feel.
  • The hospital provided vegetarian options and Halal food to meet the needs of current patients.
  • There had been no complaints at Douglas House for the last 12 months.

Are services well-led?

We rated well-led as outstanding because:

  • There was strong person-centred culture.
  • Governance arrangements and audits were comprehensive and were proactively reviewed reflecting best practice.
  • Staff welcomed the views of people who use services, relatives and stakeholders and saw this as a vital way of improving the service.
  • The registered manager clearly articulated how they had listened to patients, relatives and stakeholders and could clearly outline the changes that had been made to the service and its practice as a result.
  • There was a strong commitment to working with other agencies to improve care pathways and challenge stigma.
  • There were high levels of staff satisfaction. Staff were proud to work at Douglas House and spoke highly of the culture.
  • Staff were actively encouraged to raise concerns and changes had been made to address staff concerns.
  • There was strong collaboration and a common focus on improving quality of care and patient’s experiences.
  • The registered manager and the clinical team leader drove continuous improvement.
  • There was a clear proactive approach, for example through developing a bespoke support service to help manage the transition of patients from the hospital to the community.
Checks on specific services

Long stay/rehabilitation mental health wards for working age adults

Outstanding

Updated 4 August 2016