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Inspection Summary


Overall summary & rating

Good

Updated 5 February 2018

We rated Thornford Park as good because:

  • Risk assessments and risk management plans were detailed, thorough and up to date and patients had been involved in the development of the plans. The assessment of patients’ needs and the planning of their care was thorough, individualised and had a focus on recovery. Physical healthcare assessments and associated plans of care were thorough and consistently delivered to a high standard. Care plans had either a National Institute for Health and Care Excellence (NICE) guidance reference to an identified intervention or another nationally recognised intervention such as from the Quality Network for Forensic Mental Health led by the Royal College of Psychiatrists.

  • There were enough suitably qualified and trained staff to provide care to a safe standard. We consistently saw respectful, patient, responsive and kind interactions between staff and patients. Staff displayed a high level of understanding of the individual needs of patients. There were innovative practices used consistently across the service to engage and involve patients in the care and treatment they received, for example, the recovery star. There was a confident and thorough understanding of relational security among all of the staff. Relational security is how staff use their knowledge and understanding of their patients to ensure the ward environment is kept calm and any conflict is kept to a minimum.

  • Bed management processes were effective and there was a clear care pathway through the service from medium secure wards to the least restrictive environments, such as the shared flats. The service model optimised patients’ recovery, comfort and dignity. The needs of patients were considered at all times.

  • The service had clear guidance in place to report incidents and we saw evidence that staff learnt from when things had gone wrong. The service was responsive to listening to concerns or ideas made by patients and their relatives to improve services. We saw that when staff where able to, these ideas were taken on board and implemented.

  • Staff monitored patients’ physical healthcare and they could access specialist physical health services when needed. A GP provided regular physical health monitoring. Patients attended a well-man clinic.

  • We observed many positive engagement and interaction between staff and patients. Staff demonstrated a clear understanding of individual patient’s needs.

However:

  • Staff were not always available to facilitate section 17 leave on the forensic wards and leave was often cancelled.

  • The number of staff having access to regular supervision was below the provider’s target of 90%.

  • Not all patients were always reminded of their rights when their circumstances changed, such as on renewal of detention.

  • The seclusion room did not have a two-way intercom to ease communication between staff and patients.  Gym equipment was worn . All of these facility issues had been identified for refurbishment and upgrade in 2018

  • The recording of seclusion was documented differently across the wards. Staff made the required checks however, some was recorded electronically and some in paper form.
Inspection areas

Safe

Good

Updated 5 February 2018

We rated safe as good because:

  • Staff kept the wards clean and well maintained and patients told us that they felt safe.

  • There were enough, suitably qualified and trained staff to provide care to a safe standard.

  • Risk assessments and risk plans were detailed, thorough, up to date and patients had been involved in the development of the plans.

  • There was a confident and thorough understanding of relational security among all of the staff. Relational security is how staff use their knowledge and understanding of their patients to ensure the ward environment is kept calm and any conflict is kept to a minimum.

  • The hospital had clear guidance in place to report incidents and we saw evidence across all wards that staff learnt from when things had gone wrong.

  • There was good medicines management practice on the PICU. A pharmacist visited the unit once a week and was available to staff for out of hours consultation.

However:

  • While staffing levels were safe, staff and patients on the PICU told us that due to how unwell patients were they felt stretched.
  • The seclusion room did not have a two-way intercom to ease communication between staff and patients. The seclusion room was due for refurbishment in 2018.

  • The recording of seclusion was documented differently across the wards. Staff made the required checks however, some was recorded electronically and some in paper form.

Effective

Good

Updated 5 February 2018

We rated effective as good because:

  • The assessment of patients’ needs and the planning of their care was thorough, individualised and had a focus on recovery. Physical healthcare assessments and associated plans of care were thorough and consistently delivered to a high standard. Staff maintained ongoing physical health monitoring of patients.

  • Every one of the 68 care plans we looked at had either a National Institute for Health and Care Excellence guidance reference to an identified intervention or another nationally recognised intervention such as from the Quality Network for Forensic Mental Health led by the Royal College of Psychiatrists. The hospital had a quality improvements committee, which reviewed National Guidance, and recommendations on interventions and ensured staff were updated.

  • Throughout all of the wards the multidisciplinary teams were consistently and proactively involved in patient care. Clinical meetings were effective and patient focused and attended by a range of professionals.

  • Staff training and professional development opportunities were good quality and offered to, and taken up by staff.

  • Patients said they had good access to advocacy and advocates visited all the wards regularly.

However:

  • Not all patients were always reminded of their rights when their circumstances changed, such as on renewal of detention.

  • Staff having access to supervision was 10% below the provider’s target of 90%. Crookham unit needed to improve staff appraisals to ensure these were occurring annually but we did not see any adverse impact as a result of this.

Caring

Good

Updated 5 February 2018

We rated caring as good because:

  • Patients said staff were very caring, approachable and took a real interest in them. Carers we spoke with said that staff were very respectful. We consistently saw respectful, patient, responsive and kind interactions between staff and patients.

  • There were innovative practices used consistently across the service to engage and involve patients in the care and treatment they received, for example, the recovery star.

  • Staff took time in their interactions with patients, pre-empting when a patient was becoming distressed, using distraction techniques and demonstrating a real understanding of the patients as individuals.

  • All staff were confident and clear in how they were involving patients, family members and carers in all aspects of their care. Staff displayed a high level of understanding of the individual needs of patients.
  • Patients were involved in giving feedback about the unit and were involved directly in meetings about the meals and food offered.

Responsive

Requires improvement

Updated 5 February 2018

We rated responsive as requires improvement because:

  • There were not always staff available to facilitate section 17 leave for patients as agreed in their care plans in the forensic inpatient service. Leave was often cancelled which caused frustration and had an impact on patients, mood, well-being and potentially on their recovery.

  • The gym equipment was worn,however it was fully serviced on an annual basis.There was also new individual pieces of gym equipment on each ward.

However:

  • Bed management processes were effective and there was a clear care pathway through the forensic service from medium secure wards to the least restrictive environments, such as the shared flats.

  • Generally, the service model optimised patients’ recovery, comfort and dignity. The needs of patients were considered at all times. There was a varied, strong and recovery orientated programme of therapeutic activities available over seven days, every week.

  • The hospital was responsive to listening to concerns or ideas made by patients and their relatives to improve services. We saw that when staff were able to, these ideas were taken on board and implemented. Staff knew how to deal with complaints appropriately. Carers we spoke with all knew how to raise a complaint.

Well-led

Good

Updated 5 February 2018

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We rated well-led as good because:

  • Staff we spoke to understood the vision and direction of the organisation. Staff were able to discuss the philosophy of the wards.

  • Governance systems were in place with comprehensive clinical quality audits, human resource management data and data on incidents and complaints. The information was summarised and presented on a dashboard for managers, so they could monitor their progress and achievements.

  • Clinical audits were regularly carried out by staff to ensure treatment and therapy was effective. Staff were confident that they learnt from incidents, complaints and patient suggestions and feedback.

  • Patients told us that they were encouraged by staff to participate in making suggestions towards improving many aspects of the service. All staff and patients knew who the senior management team were and felt confident in approaching them if they had any concerns.

  • The hospital leadership team were visible and regularly visited the wards. There was evidence of a strong link between the senior team and the provider and oversight of the hospital at board level. Investments had been made into the new electronic systems and capital expenditure to improve the hospital facilities. Staff spoke very highly about their management teams and there was evidence of clear leadership at ward level. The culture on the wards was open and encouraged staff to bring forward ideas for improving care. Staff spoke of a commitment to offering a good service to patients. Staff said good team work was important so they could do their role.

  • Staff demonstrated a good understanding of the organisation’s visions and values. Staff were aware of the whistle blowing process and felt able to raise concerns.

Checks on specific services

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 5 February 2018

Forensic inpatient/secure wards

Good

Updated 5 February 2018