• Mental Health
  • Independent mental health service

Wellesley Hospital

Overall: Good read more about inspection ratings

Westpark, Chelston, Wellington, Somerset, TA21 9FF (01823) 668150

Provided and run by:
Elysium Healthcare Limited

All Inspections

14 and 15 June 2022

During a routine inspection

Wellesley Hospital, owned by Elysium Healthcare, is a purpose-built hospital in South-West England for men and women with mental health problems and/or learning disability or autism. It provides care for patients aged over 18 years.

The hospital forms part of the South West Provider Collaborative under the new care models. This programme aims to reduce patients’ length of stay and reduce the number of out-of-area patient placements.

We undertook this inspection as part of our inspection programme and inspected the following two mental health core services.

Forensic inpatient and secure wards

  • The last comprehensive inspection was on the 1st and 2nd of May 2018 where the forensic inpatient and secure wards were rated “Good.” Following this inspection our rating for the service stayed the same.
  • Many patients who are admitted to a secure service will have been in contact with the criminal justice system. Patients who are admitted to a secure hospital will be subject to detention under the Mental Health Act 1983.
  • During this inspection we inspected the following wards: Quantock ward, a medium secure wards for men, Selworthy and Mendip wards, a low secure wards for men, Blackdown ward, a medium secure ward for females and Polden ward, a low secure ward for females.

Wards for people with a learning disability or autism

  • Winsford ward opened in April 2021 and has not been inspected previously. During this inspection we have rated the service as “Good.”
  • Winsford ward provides a service for people with learning disabilities and/or autism who may be informal or detained under the Mental Health Act 1983.
  • 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 service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
  • Right support: The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. The environment met peoples’ physical needs while also feeling homely. However, although peoples’ sensory needs were considered, the sensory room was not equipped for sensory needs. For example, the room did not have a range of stimuli to help individuals develop and engage their senses such as lights, sounds or sensory soft play resources and aromas.
  • Right care: Peoples’ care was individualised, planned and delivered in a manner that met their needs. Peoples’ care promoted their dignity, privacy and human rights, Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so.
  • Right culture: Staff were supporting people with their transition to live successfully in the community. They were respectful to the people they supported. Staff placed people's wishes, needs and rights at the heart of everything they did. Staff understood the importance of family values.

Our findings

We rated the forensic inpatient and secure wards and the ward for people with learning disability or autism as good because:

  • Patients and people across both services had individual and personalised en-suite bedrooms which met their communications and physical needs. Patients and people who used services were protected from abuse and poor care and staff were knowledgeable about the signs of abuse and reporting processes.
  • Staff assessed and managed risks well. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour.
  • People on the learning disability or autism ward made choices and participated in activities which were part of their planned care and support.
  • Staff supported patients and people across both services to achieve their goals through recognised models of care and treatment. Patients and people who use services were involved in all aspects of their care and treatment and support plans. On the learning disability or autism ward easy read copies of their care plans and social stories were developed in a manner that people were able to understand. Posters were in an easy read format to ensure people understood the information on display.
  • The services managed safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients and people who use services honest information and suitable support.
  • Managers ensured they had staff with the range of skills needed to provide high quality care. They supported staff with supervision and appraisals. Staff were provided with the opportunity to develop and update their skills. Managers provided an induction programme for new staff.
  • People and those important to them, including advocates, 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, and discharged these well. The services protected people’s human rights and provided good care, support and treatment. Staff helped people with communication, advocacy and cultural and spiritual support.
  • Managers made sure that staff could explain patients’ rights to them.
  • Staff understood the individual needs of patients on the forensic inpatients and secure wards and supported them to understand and manage their care, treatment or condition. People on the learning disability and autism ward had their communication needs met and information was shared in a way that could be understood. All patients and people who use services received kind and compassionate care from staff who protected and respected their privacy and dignity.
  • Staff planned and managed discharges well. They liaised well with services that would provide aftercare. Staff did not discharge patients before they were ready and ensured they did not stay longer than they needed to.
  • The service treated concerns and complaints seriously, investigated them and learnt lessons from the results, which were shared with the whole team.
  • Leaders had the skills, vision, knowledge and experience to perform their roles and understood the services they managed. Staff felt respected, supported and valued. The service promoted equality and diversity and provided opportunities for development and career progression. Leaders understood the services they managed and had a vision for these services. They were visible and approachable for patients, people and staff.

However:

  • While the forensic inpatient and secure wards and the ward for people with learning disability or autism used systems and processes to prescribe and administer medicines safety, they did not always record, store or destroy medicines appropriately.
  • Care records on the forensic inpatients and secure wards and the ward for learning disability or autism did not identify the reasoning for providing PRN (as required) medicines or demonstrate that patients were reviewed after administration of these medicines.
  • While the services inspected had enough nursing and medical staff who knew the patients and the people who used services, and had received basic training to keep all safe, they did not have enough therapy staff to maintain daily activities on the forensic inpatient and secure wards.
  • Across both services we found staff did not always monitor or record the physical health of patients and people who use services to ensure they responded appropriately to a potential deteriorating condition.

18 June 2020

During an inspection looking at part of the service

Wellesley hospital provides forensic inpatient / secure wards to patients from the south west of England.

We carried out a focused inspection of forensic wards at Wellesley hospital. We did not re-rate this service as we only inspected one (Selworthy ward) of the five forensic wards. The purpose of the inspection was to follow up on specific concerns that had come to our attention around the management of a serious incident.

We found that:

  • The hospital managed patient incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Observations were proportionate and risk based. For example, if there was an increased risk to an individual patient or to others, the patient`s level of observations would be increased. There was an observation sheet that required staff to sign at the time of observation and note where the patient was and confirm if response was gained. In addition, every patient was observed hourly and this was recorded in the same way.
  • Selworthy ward provided safe care. The ward environment was safe and clean. The ward had enough nurses and doctors to ensure safe care and treatment for patients. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff were appropriately trained in restraint and used this as a last resort.
  • We observed 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.
  • Selworthy ward was well led, and managers fostered a culture amongst the team where staff felt able to challenge practice and raise concerns without fear of repercussions.
  • Managers within the service promoted an open and honest culture. All staff had received training on their responsibilities under the duty of candour and additional information was available on the intranet. Duty of candour is a statutory (legal) duty to be open and honest with patients, or their families, when something goes wrong that appears to have caused or could lead to significant harm in the future.

However:

  • At the time of this inspection, the investigation and analysis of the death of the patient on Selworthy ward was ongoing and staff told us they were waiting for this to share learning across the hospital.

1 and 2 May 2018

During a routine inspection

We rated Wellesley Hospital as good because:

  • Staff received appropriate training and support to keep patients safe. The number of incidents of patient on patient assaults had reduced. Patients told us they felt safe on the wards.
  • Staff used comprehensive assessments to inform care planning. Staff delivered care in line with guidance from the National Institute for Health and Care Excellence.
  • There were effective systems in place to ensure patients physical health needs were met. A local GP visited the hospital once a week and the hospital employed practice nurses. The hospital provided a number of initiatives to encourage patients to live healthier lives, including smoking cessation support and healthy eating advice.
  • The hospital employed a range of specialists required to meet the needs of the patients.
  • Staff understood and worked within the scope of both the Mental Health Act and Mental Capacity Act.
  • Staff treated patients with kindness, dignity and respect. Patients were involved in their care and treatment. Patient involvement in decisions about the service was improving and patients were able to give feedback on the service in a number of ways.
  • Facilities within the hospital promoted comfort, dignity and privacy. Improvements had been made to ensure low secure patients were not cared for in overly restrictive environments. The service listened to and learnt from concerns and complaints, including informal complaints and concerns.
  • Admissions were planned and overseen by the south west regional secure service, a partnership of eight providers working to get people the support they need as close to home as possible.
  • The service was well-led at ward and senior management level. Low morale amongst staff had been recognised and the service was working actively with staff to respond to their concerns and make changes that would benefit them.
  • The provider had a comprehensive schedule of meetings and reporting systems to ensure good governance of the service.

24 and 25 and 31 October and 1 November 2017

During an inspection looking at part of the service

  • 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