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Inspection Summary


Overall summary & rating

Outstanding

Updated 15 March 2017

We rated this service as outstanding because:

  • Wast Hills was a safe, modern and environmentally suitable facility for patients. There was a secure door entry system to prevent unwanted visitors and closed circuit television in some areas.
  • Staff managed risk well and Wast Hills had a good track record on safety. Staff undertook thorough risk assessments for each patient on admission, which they updated regularly. They also carried out environmental risk assessments and ensured equipment was tested and calibrated effectively.
  • Staff had received training in safeguarding adults, and regularly reported safeguarding concerns to the local authority. Mandatory training compliance levels for staff were good.
  • Staff knew how to report incidents. Local managers investigated incidents and there were systems in place so senior managers had oversight of outcomes. Local managers and the wider company shared lessons learned with staff in meetings and in a monthly newsletter.
  • Wast Hills had safe systems to manage medication and to prevent the spread of infection.
  • There was an ongoing recruitment programme to fill vacancies and managers had recruited a small bank of temporary staff to support the permanent team, most of whom were already familiar with the service. The company had agreed funding to “over fill” nursing vacancies so the unit would not be short staffed when patient numbers grew.
  • Commissioners, families and external staff who visited Wast Hills told us they believed the service was safe and patients were cared for safely.
  • Staff followed a model of care called ‘Personal PATHS’ that was developed by the Danshell Group. PATHS supported patients across five areas; positive behaviour support, appreciative enquiry for staff, patients and carers to reflect, to achieve therapeutic outcomes, promote healthy lifestyles, and provide safe services.
  • Staff provided good quality care and treatment. They routinely supported patients to address their physical healthcare needs as well as their emotional needs. Different professionals worked very well together to assess and plan for the needs of their patients.
  • The service followed Department of Health and the National Institute for Health and Care Excellence guidelines. Staff were able to access specialist training relevant to their roles. Staff used specialist tools to assess the specific needs of their patients.
  • All patients had up-to-date care plans. These focused on positive behaviour support, person-centred care, treatment, rehabilitation and independence-building skills as well as social and leisure-based activities.
  • To support their treatment, patients had access to specialist therapies, which included speech and language therapy, psychology, occupational therapy and creative art. Staff were keen to support patients to develop special interests and we saw examples of patients trying new experiences as well as things they had enjoyed for a long time. Some patients were involved in work experience placements. Staff encouraged patients to celebrate their achievements.
  • Staff had a very well developed understanding of the Mental Capacity Act 2005 and the Mental Health Act 1983. Assessing mental capacity and enabling patients to make decisions was thoroughly embedded throughout the service. Staff routinely referred patients for advocacy support if they lacked the capacity to do so themselves. Mental Health Act and Deprivation of Liberty Safeguards paperwork was all in order and was effectively stored.
  • Commissioners and community teams were extremely positive about the service and each commented on the high quality of multidisciplinary working and associated paperwork.
  • Staff used the positive behaviour support model, which ensured they understood patient behaviours and responded in ways which promoted patients’ rights, preferences and communication needs.
  • Staff treated patients with kindness, dignity and respect; and were able to accurately anticipate the needs of patients who could not verbally communicate.
  • Staff ensured patients and relatives were engaged with assessments, care plans and discharge arrangements. Patients were involved in developing their own care plans and staff gave them copies which were in an “easy read” format.
  • Staff routinely sought feedback from people who used the service including patients, relatives, community teams, commissioners and staff. The company analysed this feedback and made changes as a result.
  • Almost all relatives said they knew how to make a complaint and believed staff would deal effectively with any complaint. Relatives of patients using the service were highly complimentary and positive about the programme, the staff and the progress patients had made.
  • The service went to extensive lengths to meet the needs of patients who were ready to move but had nowhere to go.
  • Local managers led their team very well. They were available and accessible to staff. Staff and patient families spoke very highly of the local managers. Managers routinely held supervision and annual performance reviews with staff. They monitored mandatory training to ensure compliance. Managers did not tolerate poor staff performance and took effective action if any concerns came to light.
  • The company invested in, and was responsive to the needs of staff. As a result, staff morale was very good. Managers listened to their staff and provided them with additional resources when they needed them.
  • Staff had access to specialist training and the company routinely supported them to undertake vocational and academic study such as Masters degrees and diplomas. The company supported staff who needed to work flexibly due to caring commitments and provided confidential support and counselling if staff needed it. There were a range of benefits available to staff.
  • The service had a detailed audit programme, the outcomes of which were open and transparent. The service had good systems in place so they could monitor and audit the quality of care. The senior management team were accessible to staff and local managers.
  • The service was in the process of becoming accredited with the National Autistic Society.
  • Between May 2015 and April 2016, a serious case review took place, which looked at issues surrounding the treatment and discharge of a patient at Wast Hills. The patient had been at Wast Hills between July 2013 - March 2014. During this inspection, we found that Wast Hills had addressed the issues raised in the Serious Case Review. We found they had changed their processes, implemented new procedures and improved monitoring.
Inspection areas

Safe

Good

Updated 15 March 2017

We rated safe as good because:

  • The Main House was visibly clean, clutter free and well maintained.

  • The service had policies for protecting patients from avoidable harm and all staff understood how to recognise and report safeguarding concerns.

  • The service did not practice seclusion and only used restraint as a last resort. Staff did not use prone restraint. The use of restraint was monitored and learning discussed across the service.

  • There were low vacancy rates for nurses and support workers. Managers were recruiting to fill the vacancies. There was only one other vacancy at Wast Hill, for a secretary. There was low use of agency and bank staff but those used were familiar to staff and patients.

  • The service had a thorough induction process for all staff, including agency or temporary workers.

  • Staff carried out appropriate risk assessments, to keep patients safe, and updated them regularly.

  • The service carried out regular checks to ensure the buildings and environment were safe for staff and patients.

  • Staff completed their mandatory training and managers monitored their attendance to ensure compliance. Overall compliance met the company target. .

  • The unit had medication management policies in place and an independent pharmacy carried out regular audits.

  • There was no pressure from the company for staff to fill hospital vacancies. Staffwere given the autonomy to decline referrals for patients they did not feel able to support effectively.

  • Staff knew how to report incidents or risks of harm. Staff logged incidents and managers investigated them. The service used staff meetings and a monthly staff newsletter to share information about incidents so they could learn lessons from anything that had gone wrong.

  • Clinic rooms were well stocked and effectively organised.

  • The service advised the Care quality Commission of all required statutory notifications.

However:

  • Staff turnover rates were high.

  • Mandatory training levels in some areas were below the company compliance target.

Effective

Outstanding

Updated 15 March 2017

We rated effective as outstanding because:

  • The ‘Personal PATHS’ model of care, developed and used by the service, had recently been reviewed and endorsed by an external psychiatrist who was a specialist in the field.This model incorporated positive behaviour support, learning from incidents, the promotion of healthy lifestyles, safe care and treatment and therapeutic outcome measures including discharge planning.

  • Staff, including domestic and maintenance staff, were trained in positive behaviour support and the Mental Capacity Act.

  • Staff used the “intensive interaction” model to learn how to get communication and social relationships started with patients from admission.

  • All patients had a Health Action Plan and a Hospital Passport. Best practise recommends these for people using learning disability and autism services. This meant health promotion was consistently considered in care plans and important information for each patient was available to external health professionals, for example, if patients needed urgent health care.

  • Wast Hills used service specific outcome tools that met the needs of patients who have a learning disability and autism. These included the Health Equalities Framework, which is endorsed by the National Valuing Families Forum. Staff also used the Triangle Outcome Star for people with autism and the Health of the Nation Outcome Scales for people with learning disabilities.

  • Staff planned and delivered patient care and treatment in line with current guidelines from the Department of Health and the National Institute for Health and Care Excellence (NICE).

  • In line with NICE guidelines and the Mental Health Act Code of Practice (2015), patients received thorough physical health checks and medical care to promote their health and wellbeing.

  • The Department of Health’s “Positive and Proactive Care: reducing the need for restrictive interventions” (2014), was embedded within the service.

  • External professionals praised Wast Hills for their high quality multidisciplinary and inter-agency working practices, noting they were amongst the best they had seen.

  • External professionals were highly positive about the progress their patients made at Wast Hills, noting significant reductions in self-harm behaviours, incidents and observation levels.

  • The service had a mix of staff from different professions to provide a full multidisciplinary service. External professionals commented on the exceptional knowledge each member of the multidisciplinary team showed for patients.

  • Record keeping throughout the service was to a very high standard.

  • Staff received regular supervision and an annual appraisal. Compliance rates were high.

  • Patients could access other health services when they needed them. We saw staff routinely arranged ophthalmic and dentistry appointments for patients. The service made private arrangements for physiotherapy when patients needed it.

  • Care plans were up-to-date, showed patient and family involvement, and staff regularly updated them to reflect changes in patient need. Language used in care plans was person centred and meaningful to patients and their families.

  • Staff developed detailed activity and therapy programmes, which gradually increased patients’ exposure to new things and slowly increased their independence.

  • Psychological therapies, such as cognitive behavioural therapy, were available for patients.

  • Staff had a detailed and embedded knowledge of the Mental Capacity Act, which meant they consistently assessed capacity.

  • Staff had a good understanding of the Mental Health Act. Patients had access to third tier Mental Health Review Tribunals, managers’ hearings, and mental health advocacy. Staff routinely made patients aware of their rights under the Mental Health Act and had a good process for recording section 17 leave.

Caring

Outstanding

Updated 15 March 2017

We rated caring as outstanding because:

  • We spoke with 13 relatives of current patients at Wast Hills. They were overwhelmingly positive about the service Wast Hills provided to their relatives. A number of families told us their relatives were much happier since moving to Wast Hills.

  • We received 10 comment cards and all were highly positive about the care and treatment provided at Wast Hills. They complimented the service, its treatment programme and the manager.

  • We observed the care delivered by staff through structured observations. These observations showed interactions between patients and staff were relaxed, humorous and meaningful. We observed many kind, intuitive and caring interactions between staff and their patients.

  • We saw that staff supported patients in a compassionate, kind and timely way. They treated patients with dignity and respect.

  • We spoke with four commissioners from three different commissioning groups and four community nurses all of whom spoke very positively about the care and treatment provided by Wast Hills staff.

  • The service actively encouraged families to play a part in the running of the unit. A family representative routinely attended the unit led clinical governance meeting.

  • There was an independent advocacy service which regularly visited the hospital. Staff routinely referred patients if they felt the person would benefit, even if they lacked the capacity to know an advocate might be helpful. The advocate spoke very highly of Wast Hills staff and the service.

  • Staff involved patients and their families as real partners in their care, treatment and rehabilitation.

  • Patients and relatives told us staff treated patients in a kind and caring way.

  • To promote patients’ wellbeing, staff used positive behaviour support to effectively understand, anticipate and meet patients’ needs.

  • Patients chose how to decorate their rooms and staff used individual communication tools to determine colours and items of special interest which might please and comfort patients who could not verbalise their preferences.

  • Staff anticipated needs then responded immediately and compassionately to their patients.

  • Patients were encouraged to learn new skills and to develop independence with whatever skills they could. Staff encouraged patients to celebrate their successes and used a strengths based approach.

  • Staff prepared care plans in a format which was accessible to individual patients.

  • The service supported patients to establish goals and develop a better understanding of their needs and how to then communicate those needs.

Responsive

Good

Updated 15 March 2017

We rated responsive as good because:

  • The service went above and beyond what would be reasonably expected of them to meet the changing needs of individual patients, even though it meant bedroom numbers would be reduced and the cost of redesign work was substantial.

  • There was no pressure from the company for staff to fill hospital vacancies. Staff were given the autonomy to decline referrals for patients they did not feel able to support effectively.

  • Staff assessed patients for the service in a timely manner. They kept referrers informed about the referral and assessment process.

  • The service worked well with other agencies to support patients to move on from the hospital.

  • Discharge was discussed early into admission. The pathway toward discharge was open and transparent for patients, their families and commissioners to understand. Staff provided regular updates to commissioners so they could track patient progress. They proactively discussed potential or actual delays in discharge with commissioners and external agencies. Wast Hills routinely sent their staff long distances to support discharge or transition arrangements for patients.

  • Patients could access the right care at the right time because they had a range of professionals on site who worked very well together to support them.

  • Staff constantly reviewed the general environment to ensure it met the needs of patients.

  • Families knew how to raise concerns and there were opportunities for them to provide feedback about the service.

  • The service had reviewed and acted upon the recommendations of a serious case review

Well-led

Outstanding

Updated 15 March 2017

We rated well led as outstanding because:

  • Wast Hills was awarded The Great Autism Practice Award at the 2016 National Learning Disabilities and Autism Awards. They won the award for providing, what judges described as, "a passionate, person centred and outcome focused service that is delivering truly great innovative services and transforming the lives of the people they are working with”.

  • The service had been cited as a source for best practice in the Public Health England document “Making reasonable adjustments for people with learning disabilities in the management of constipation” (August 2016).
  • The service was involved in national research. The mATCH study - “People with Autism detained within hospitals: defining the population, understanding aetiology and improving Care Pathways” – a three year project, commenced in October 2015.
  • The leadership, governance and culture within the service promoted the delivery of quality, person-centred care. Staff and managers showed a great commitment towards continual improvement and innovation. They were openly proud of their service and keen to showcase their achievements.
  • The service was in the process of becoming accredited with the National Autistic Society.
  • A nominated family member formed part of Wast Hills’ clinical governance meeting. They were able to bring a family carer perspective to the meeting.
  • Managers carried out regular staff, family and patient satisfaction surveys. They routinely sought written feedback from external professionals for example using feedback forms for each Care Programme Approach and Care and Treatment Review meetings.
  • The service was very responsive to feedback from patients, staff and external agencies. Based on feedback they received, staff looked for ways to improve how they did things.
  • Local managers were visible and available to staff, patients and families. Senior company leaders regularly visited the unit.
  • Managers listened to their staff when they described having seen poor practice for Wast Hills’ patients in other health settings. Managers met with these providers to agree an action plan, which led to improvements in patient care.
  • Wast Hills staff delivered free training and education to community facilities such as hotels and leisure services where patients enjoyed activities.
  • Morale amongst staff was very good. Staff were proud of the work they did and wanted to talk about it. The service used a “Positive Events Log” where staff wrote positive comments and recorded praise for their colleagues.
  • Staff were confident they could speak up if they had concerns and felt their managers would listen and support them.
  • There was clear learning from incidents and managers openly shared these with staff at the unit and across the company.
  • There were good development opportunities for staff. Managers supported them to attend specialist training courses and national conferences so they could develop their careers and share best practice.
  • Staff identified the need for specialist training to work with people who had personality disorders. Managers listened to this and provided training, which staff felt improved their knowledge and skill.
  • The service routinely monitored the quality of the care they provided. They had a detailed rolling audit programme and measured outcomes across the company.
  • The company provided many staff benefits for its workforce.
Checks on specific services

Wards for people with learning disabilities or autism

Outstanding

Updated 15 March 2017