The Care Quality Commission
  • Mental Health
  • Independent mental health service

Adarna House

Overall: Good read more about inspection ratings

279-281 Beacon Road, Wibsey, Bradford, West Yorkshire, BD6 3DQ

Provided and run by:
Caireach Limited

All Inspections

03 May 2022 and 04 May 2022

During a routine inspection

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.

Right Support

  • Staff did everything they could to avoid restraining people and there had been no restraint used since opening on 10 January 2022.
  • The service gave people care and support in a safe, clean, well equipped, well-furnished, and well-maintained environment that met their sensory and physical needs.
  • Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
  • Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. However, there was no access to activities linked to work or education and all the people we spoke to who used the service said there were not enough activities.

Right care

  • Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
  • People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
  • People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
  • Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

  • People received good quality care, support, and treatment because trained staff and specialists could meet their needs and wishes.
  • People were supported by staff who understood best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.
  • Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
  • Carers and relatives were not always included in the planning of people’s care. Two relatives told us they were not informed about the care their relative received.

16 and 17 March 2021

During a routine inspection

We expect health and social care providers to guarantee autistic people and people with a learning disability 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.

We rated Cygnet Woodside as inadequate because:

  • The service could not show how they met some of the principles of ‘Right Support, Right Care, Right Culture’.
  • The hospital website stated that it provided assessment, treatment and fast stream rehabilitation but most people had been at the hospital for long periods of time.
  • People's needs were not fully met by the physical environment of the hospital. The environment was not fully suited or adapted to meet people’s needs, including their sensory needs.
  • Staff did not monitor and evaluate each person’s outcomes meaningfully and review their support plan and adapt it where necessary. Each person’s programme did not offer sufficiently intensive learning opportunities to promote skills acquisition, support community inclusion and reflect planning for the future discharge.
  • The support provided to the person was not seamless across services and between professionals involved in the person’s life. People did not have access to the full range of multidisciplinary team members.
  • The culture of the hospital did not fully support people using the service to lead confident, inclusive and empowered lives. The needs of people did not form the basis of the culture at the service to develop their skills to enable them to move out of hospital as soon as possible to live successfully and safely in the community. The provider’s systems and policies did not always support staff to provide care that was genuinely person-centred.
  • Leaders of the service had made some improvements since the last inspection but this was not always fully effective and did not always consider how people’s quality of life could be fully promoted and how it fully had regard to ‘Right Support, Right Care, Right Culture’.

15 & 23 September 2020

During an inspection looking at part of the service

We have rated Cygnet Woodside as inadequate because:

  • We have taken enforcement action against the registered provider in relation to our concerns about this location. This limits our overall rating of this location to inadequate.
  • Allegations of abuse towards patients were being investigated at the time of our inspection and there had been a delay in staff reporting allegations of abuse to managers. Senior leaders were not always fully sighted on concerns in the service including the allegations of abuse towards patients.
  • The service had inherent risk factors and warning signs that increased the risk of developing a closed culture.
  • Governance processes were not always effective, and we identified a range of areas that required improvement.
  • Staff did not always adhere to government guidance and the service’s Covid 19 risk assessment on wearing facemasks, bare below the elbows practices and tying back long hair.
  • Staff did not follow good policies and procedures for use of observation in line with national guidance and did not record when patients were observed safe and well.
  • Managers did not ensure that staff received an appraisal and supervision in line with the provider’s policy. Team meetings had not taken place for at least three months.
  • Staff did not always follow patients’ activity and therapy plans or provide support in line with care plans and positive behavioural support plans.
  • The service relied on bank and agency staff and there was a high turnover of regular staff. Shifts fell below the minimum numbers required and this had an impact on the ability to respond to incidents. Agency staff did not receive an induction.
  • Staff had a basic understanding of safeguarding. Some staff previously had not raised concerns because they felt intimidated by other staff and some staff felt their concerns were ignored by managers.
  • Incident reporting processes were not effective. Not all staff understood how to report incidents appropriately and staff did not report all the incidents that they should. Incidents were not always discussed at meetings to review patient risk and staff did not always receive a debrief and support following incidents.
  • The service had areas that were not clean or well maintained, and the main ward area had a strong odour of urine.
  • Restraint training provided to staff had not considered the physical ward environment and individual patients’ needs and staff told us they did not always use correct restraint techniques.
  • There were lapses in some patient records because staff did not always complete and keep patient risk assessments up to date, two records did not contain all the admission assessments required and one patient, whose discharge was delayed, did not have a discharge plan.
  • Some patients had limited access to some communal areas of the hospital.
  • Managers did not ensure the risk register clearly showed actions that were ongoing and those that were closed.
  • The service did not notify us of a Deprivation of Liberty Safeguards application and authorisation.

However:

  • Managers were open and transparent with patients and families when something went wrong.
  • Most care plans were personalised, holistic and recovery oriented.
  • Patients had access to information in accessible formats.

13 - 15 May 2019

During a routine inspection

Our rating of this service improved. We rated it as good because:

  • The ward environments were safe and clean. The wards had enough nurses and doctors. Staff managed medicines safely, 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.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They 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 engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked together as a multi-disciplinary 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. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service worked inline with the transforming care programme. It was well led and the governance processes ensured that ward procedures ran smoothly.

However;

  • Staff did not always assess and manage risk following physical interventions.
  • Clinical staff were not trained in immediate life support.
  • The service had a high rate of staff turnover, changeable multi-disciplinary team membership and a significant increase in whistle blowing notifications which impacted the team dynamics and culture within the service.

13 & 14 March 2018

During a routine inspection

We rated Woodside as requires improvement because:

Woodside’s systems and processes were not established or operating effectively to assess monitor and improve quality and safety and mitigate risks in a number of areas.

The service had undertaken a number of audits. However, these failed to highlight key issues, for example with documentation and the compliance of the Mental Capacity Act. The service had not recognised and reviewed, or individually risk assessed, the use of some blanket restrictions in line with the Mental Health Act Code of Practice including access to the kitchen and outside space.

Staff were not fully supported in their roles. They did not receive regular clinical and management supervision nor were they up to date with mandatory training despite this being part of the weekly key performance indicator recording and monitoring for the organisation.

Staff were unsure of their roles and responsibilities under the Mental Capacity Act 2005 despite the high staff training compliance rate for this course. Patient records showed very few capacity assessments for patients regarding decisions around care plans and activity plans.

Not all staff could access the electronic records or contemporaneous patient information at all times. We found the records were not always complete or reflected the patients’ care and treatment, including family involvement, physical health observations and investigations, and the rationale for administering as required medicines. Care plans reviewed were not specific to patients’ communication needs; just one of the eight patients in the service had an easy read care plan.

The staffing establishment levels were not appropriate to support shifts as required without additional bank and agency staff. Staff patients’ and carers told us that at times escorted leave was rearranged or cancelled because there were too few staff to either accompany or drive patients. Therefore, the service was not consistently ensuring that sufficient staff were deployed to deliver activities relating to patient treatment and care. Doctors on the on call rota lived some distance away from the hospital therefore were not immediately available following an incident of restraint.

Whilst there were a range of policies which were regularly reviewed and supported good medicines management, we found some issues relating to medicines administration, storage and management.

However:

Woodside provides recovery focused care to its patients from a multi-disciplinary team. Staff clearly understood patient needs. We saw they worked and interacted with patients in a very positive and caring manner. Patients and carers spoke highly about the staff and provision of care.

The manager was approachable and supported staff. Regional managers visited Woodside regularly and all staff knew the senior management. The multidisciplinary team meetings were effective as patients were reviewed regularly including changing presentations; risks and the level of support required facilitating recovery and discharge.

The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers and the multidisciplinary team investigated incidents and made changes to patient care where necessary.

Woodside was a clean environment, with clear signs and well displayed information. Posters and leaflets described key information and processes for patients in different forms including easy read and pictorial. Patients were encouraged to personalise their bedrooms and have input into the food choices for the menu, which was changed frequently. Staff made healthy, quality food on site for patients.

23 and 24 March 2015

During a routine inspection

Woodside had previously been run by Woodleigh Care and since December 2014 has been taken over by the Cambian Group. The unit was very much in a period of change. However, staff appeared to find these new changes positive and they felt it would have a positive impact on patient care. They reported that the hospital manager was supportive and effective for all staff.

Overall patients and staff said they felt safe on the unit and we found Woodside to be effective, caring, responsive and well led.

There were sufficient staff on duty to carry out tasks, activites and physical interventions. Staff were trained in all areas to high compliance except in the area of intermediate life support.

The unit did not have a seclusion facility or low stimulation area and we found that staff's skills in de-escalation were to a high standard.

Action plans following the non-compliance at our last visit had been put in place to address our concerns. We could see that these had been monitored and driven forward to ensure progress happened. Actions from these plans were implemented and we were able to see this on the inspection.

We did find

That the controlled drugs were only being checked and signed daily by one member of staff rather than two and that the controlled drug key was held with the main drug keys. This was contravening the NMC code of practice guidelines and also Woodside’s own medicine management policy. This was immediately drawn to the attention of the hospital manager. Staff also gave patients water to consume their medication in plastic cups which were then washed between patients. This was not good prevention of infection control

20, 22 January 2014

During a routine inspection

During our visit seven patients were detained under the Mental Health Act. This meant that they were there to ensure the safety and wellbeing of themselves, and others, and there were certain restrictions on what they could do and the decisions they could make.

The inspection was carried out over two days. The inspection team consisted of two inspectors and a Mental Health Act Commissioner who visited the ward and looked at whether the service was detaining patients appropriately and following the Mental Health Act 1983 Code of Practice.

We found patients' needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We talked with one patient who told us they were seen by their Consultant every week and a psychologist had 'helped' them for seven months. They told us they were able to talk with the staff and were supported to carry out activities in the community. They said 'It was the best hospital they had been to'.

We talked with three relatives they told us the service was 'Really good, their relative was doing really well, they had stabilised and improved since they moved into the service'. 'Progressed really well'. 'Welfare spot on, their hygiene has improved enormously'. 'Every decision goes through the Multi-disciplinary team'. They 'Had no concerns about how they were managed'. Two told us that they thought Woodside was as 'Good as it gets".

We found there were arrangements in place to make sure there were enough qualified, skilled and experienced staff to meet patient's needs. One patient told us the staff did listen to them, and there were enough staff to provide them with the support they needed and to enable them to access the community when they wanted. Three patients' relatives said 'The care staff were fantastic', 'The staff were very skilled at their job' When staff supported patients to visit their homes the staff were always respectful to the patient and their families.

However we found improvements were needed to the systems the provider used to safeguard patients from both abuse and self-harm. We also found that the patient records were not always reviewed and maintained to an appropriate standard.

7 January 2013

During a routine inspection

During our visit all nine patients were detained under the Mental Health Act. This meant to ensure the safety and wellbeing of themselves, and others, there were certain restrictions on what they could do and the decisions they could make. We spoke with four patients. They told us they enjoyed the meals and there was a good choice of food and drink available to them.

Patients were happy with the care and support they received. One patient said 'I would give 10 out of 10 for the staff, my care, the food, the surroundings and other the residents'. Patients said staff regularly spoke with them about their care and treatment. One patient told us, 'if you have any queries you just ask staff and discuss it with them, they always listen to our points of view'.

Patients told us they felt safe and said staff were kind and treated them with respect. One patient said 'the staff are respectful to me and are helping me get better'.

We found there were effective systems in place to protect people from the risk of the spread of infection. We saw there were enough staff to meet patients's needs.

Patients and their representatives were regularly asked for their views about the quality of the service and any recommendations they made were acted upon.

10, 11 January 2012

During a themed inspection looking at Learning Disability Services

At the time of the inspection visit, there were six patients present. We met and introduced ourselves to all six patients and spoke with four patients in more depth to get their views of the service.

Patients told us they were very happy with the care and treatment at Woodside. There were lots of activities that patients said they were involved in. Patients told us the staff supported them to be involved in putting their care plans together and they could choose who they wanted at their review meetings. One patient showed us their plan and said, 'Staff sit with me and talk about my care plan and meetings.'

Some mentioned that they had advocates. (Someone from outside of Woodside who came in and spoke up for them.)

We spoke with the relatives of three patients about how they felt about the care, treatment and support provided. They gave very positive feedback about the service, saying that their relatives were happy, well cared for and had made good progress.

We also spoke with a number of other professionals including two social workers and two community nurses, along with an independent advocate. They were all visiting for patient's reviews. Two occupational therapy students were also undertaking some quality assurance work in the service. All of their feedback about Woodside was very positive. One comment was that the staff could not be praised highly enough. Another was, 'I've had a marvellous experience working with the director and staff at Woodside. Think they should get a tick in every box.'

There were patients in the unit who we were not able to talk with to gain their views because we were not familiar with their ways of communicating. We used the SOFI tool to observe how two patients were spending their time and this was very helpful, and showed that there was very positive interaction between the staff and the patients.

The expert by experience who was part of our inspection team said that they thought that there was a nice atmosphere in the unit and staff were very friendly and chatty. They thought that it was good that there was lots of artwork that had been done by patients, nicely displayed on the walls around the unit.