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Inspection Summary


Overall summary & rating

Updated 8 February 2018

  • The monitoring of side effects following rapid tranquilisation (RT) was not always completed in line with the National Institute for Health and Care Excellence (NICE) guidance. Not all registered nurses knew where Flumazenil, (which is a medicine that is used to reverse the potentially harmful effects of benzodiazepine medication), was kept or what it was for. Although improving, there were various medication administration errors on Mendip ward, including missed staff signatures. Records to show that emergency medical equipment on Mendip ward was checked regularly was missing or incomplete.
  • Mendip ward was currently experiencing a high volume of patient on patient and patient on staff assaults. This was due to the current mix of patient’s. All five patients we spoke with shared concerns relating to staffs ability to safely diffuse situations. Although there was a comprehensive induction programme for all new starters at the hospital, this had failed to ensure that staff understood the differences between patients being nursed within a medium and low secure setting. Morale was varied at the hospital. Some staff that we spoke with prior, during and post the inspection visit described low morale, but did not feel able to raise this with senior managers for fear of recrimination. Not all staff said that their colleagues represented the values set by Elysium Healthcare, describing situations where communication could be better.
  • The rights of patients on Mendip, the low secure ward, were not being protected. Policies and procedures that should have been in place to protect the rights of patients not requiring medium security were either inadequate or missing. Care records were not in line with professional standards for record keeping. Daily records relating to patients general wellbeing, mental health and activity levels were either missing or poorly recorded. Care pans relating to specific health needs and or patient activities were poorly recorded and or absent. Records relating to the seclusion of patients were either completed incorrectly and / or incomplete. Dental care was available for patients who were able to leave the hospital but was not available for those that could not.

However:

  • Ligature risks had been reduced by minimising ligature points within the building. Ligature assessments were up to date and available on each ward. There was a meeting each weekday morning to discuss incidents, staffing and other risk related issues.
  • Safeguarding events were recorded by staff and information sent to the safeguarding lead for further consideration and escalated to the local authority if necessary. The importance of relational security was covered in the staff induction. There was access to an advocate Monday to Friday.
  • The assessment of patient’s physical health was completed on admission and routinely and regularly thereafter. We observed staff interacting with patients in a patient and caring manner. Community meetings were held weekly on both wards. There was a patient council group within the hospital. A daily planning book was completed by patients in partnership with the lead occupational therapist (OT). All patients had their own bedrooms with ensuite facilities
Inspection areas

Safe

Updated 8 February 2018

  • Mendip ward was experiencing a high volume of patient on patient and patient on staff assaults. This was due to the current mix of patients.
  • The monitoring of side effects following rapid tranquilisation (RT) was not always completed in line with the national institute for health and care excellence (NICE) guidance. Flumazenil, which is a medicine that is used to reverse the potentially harmful effects of benzodiazepine medication, was available on both wards. However, not all registered nurses we spoke with knew precisely where it was kept and or what is was used for.
  • Emergency medical equipment was checked regularly by staff on Quantock ward. However, Mendip ward had failed to ensure that medical emergency equipment was being checked on a regular basis.
  • Although improving, there were various medication administration errors on Mendip ward, including missed staff signatures. This meant there was a risk of patients not receiving safe care and treatment.
  • Records relating to the seclusion of patients were not appropriately completed.

However

  • Ligature risks had been reduced by minimising ligature points within the building. Ligature assessments were up to date and available on each ward. Ligature cutters were available on both wards and staff we spoke with, knew where and how to access them.
  • Safeguarding events were recorded by staff and information sent to the safeguarding lead for further consideration and escalated to the local authority if necessary.
  • Both wards had a de-escalation area and seclusion room, with ensuite facilities available and access to secure outside space. There was clear observation of all parts of the seclusion room.
  • Medication management procedures were in place including the storage and disposal of medicines. Fridge temperatures where medication was stored were within range and checked regularly.

Effective

Updated 8 February 2018

  • Care records were not in line with professional standards for record keeping. Daily records relating to patients general wellbeing, mental health and activity levels were either missing or poorly recorded. Care pans relating to specific health needs and or patient activities were poorly recorded and or absent. Most care plans showed evidence of cut and pasting, with standardised care plans containing the same information for most patients. There was very little evidence of patient involvement in the planning of their own care and treatment.
  • All five patients we spoke with shared concerns relating to staffs ability to safely diffuse situations. Some patients described times when they have intervened in order to ensure no further harm came to any persons involved.
  • Although there was a comprehensive induction programme for all new starters at the hospital, this had failed to ensure that staff understood the differences between patients being nursed within a medium and low secure setting.
  • Dental care was available for patients who were able to leave the hospital but was not available for those that could not.

However

  • The assessment of patient’s physical health was completed on admission and routinely and regularly thereafter.
  • The hospital had on display information relating to the ‘see think act’ initiative which aims to promote and raise awareness of the importance of relational security in secure care settings. The importance of relational security was covered in the staff induction.
  • Although there were vacancies within the multi-disciplinary team, patients had access to a range of professionals including medical and nursing staff, social workers, psychologists and occupational therapists. There was access to an advocate Monday to Friday.

Caring

Updated 8 February 2018

  • All patients we spoke with were positive about the care and treatment they received from medical staff. Patients particularly appreciated the badminton sessions held by one doctor.

  • We observed staff interacting with patients in a patient and caring manner, which at times, was good humoured and light-hearted.

  • Community meetings were held weekly on both wards. There was a patient council group within the hospital and each ward had a patient representative that would attend.
  • A daily planning book was completed by patients in partnership with the lead occupational therapist (OT).

However

  • Care records did not always demonstrate patient participation.

Responsive

Updated 8 February 2018

  • The rights of patients on Mendip, the low secure ward, were not being protected. Patients on Mendip ward who did not require care in line with medium security were subject to the same policies and procedures as the patients on the medium secure ward. Patients within low and medium security will typically have complex mental health disorders, a proportion of which would have come into contact with the criminal justice system at some point. The varying levels of security are designed to respond to the level of risk posed by patients to others. The lower the security level – the lower the risk posed. Policies and procedures that should have been in place to protect the rights of patients not requiring medium security were either inadequate or missing.

  • Access to mobile phones was not clearly defined in either policy or the admissions information booklet.

However

  • Most of the patients currently at Wellesley Hospital were transferred from other health facilities around the country. For most patients this meant being nearer to their families. Families and children were able to visit patients at the hospital by prior arrangement.

  • All patients had their own bedrooms with ensuite facilities. Patients were able to personalise their bedrooms and we saw evidence of this by way of family photographs, books and ornaments.

  • There was a range of activities available, including at weekends. The occupational therapy (OT) programme was overseen by the lead OT and included art and craft sessions, healthy eating groups and social events. IT equipment was available at the hospital, subject to risk assessment. We met patients with specific interests, including music and books. One patient was able to source a range of reading material and as a result, with the intention of opening a library at the hospital.
  • A recovery college initiative was being developed and we saw minutes of the development meeting for August and September.
  • There was a clear system in place to respond to complaints.

Well-led

Updated 8 February 2018


  • The senior team did not have full oversight of the fact that some of the care being delivered at the hospital was restrictive. There were no clear systems in pace to identify where this was occurring.
  • The hospital was subject to a policy migration plan (the hospital had previously been under the ownership of Partnerships in Care), however, this was slow and only a few up to date policies were in place.
  • Morale was varied at the hospital. Some staff that we spoke with prior, during and post the inspection visit described low morale, but did not feel able to raise this with senior managers for fear of recrimination. Many staff expressed their concerns about the patient mix on Mendip ward and the high level of incidents and potential for injury to both staff and patients.
  • Not all staff said that their colleagues represented the values set by Elysium healthcare, describing situations where communication could be better.

However

  • There was an obvious commitment from the senior staff management team, to ensure that Wellesley hospital evolved into a safe and caring environment for patients.
  • There was a meeting each weekday morning to discuss incidents, staffing and other risk related issues. Members of the multi-disciplinary team, senior managers and ward managers attended.