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The WoodHouse Independent Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 28 December 2017

We rated The Woodhouse Independent Hospital as good for the Safe domain because:

  • During the most recent inspection, we found that the service had addressed the issues that led us to rate the Safe domain as requires improvement following the January 2017 inspection.
  • We found that when staff gave oral medication for the purposes of rapid tranquillisation, they completed the necessary physical observations. The provider had removed restrictions that meant that it no longer had a patient living in long-term segregation. The provider had a floating nurse to support the wards for people with learning disabilities or autism, in addition to the staffing establishment for each of the wards. Moneystone ward had sufficient staffing levels to meet patients’ needs.

  • We found that the provider had allocated a lead nurse for infection prevention and control to the wards for people with learning disability or autism. Staff completed checks on emergency bags on all the wards. Staff completed records to show they had cleaned portable clinical equipment on all the wards. Staff had de-cluttered and tidied the storeroom, and cleaned, redecorated and re-floored the sluice room on Moneystone ward.
  • The provider offered overtime to its staff and had a bank staff system to help fill shifts. The provider used agency staff frequently, and wherever possible, they tried to use staff who were familiar with the service. Most staff in the core service had received training in autism.

However:

  • Staff did not always record the time of the physical observations they completed after they gave oral rapid tranquillisation.
  • There were different processes for recording physical observations on the wards.
  • The provider’s rapid tranquillisation policy lacked guidance on monitoring physical observations after oral rapid tranquillisation. 
Inspection areas

Safe

Good

Updated 28 December 2017

We rated safe as good because:

  • When staff gave oral medication for the purposes of rapid tranquillisation, they completed the necessary physical observations.
  • The provider had removed restrictions that meant it no longer had a patient living in long-term segregation.
  • The provider had introduced floating nurse cover for the core service, in addition to the staffing establishment for each of the wards.
  • Moneystone ward had sufficient staffing levels to meet patients’ needs.
  • The hospital had allocated a nursing lead for infection prevention and control to the wards for people with learning disability or autism.
  • Staff completed checks on emergency bags on all the wards.
  • Staff completed records to show they had cleaned portable clinical equipment on all the wards.
  • Staff had de-cluttered and tidied the storeroom, and cleaned and redecorated the sluice room on Moneystone ward.
  • The provider offered overtime to its staff and had a bank staff system to help fill shifts. The provider used agency staff frequently, and tried to use staff who were familiar with the service.
  • The wards had safe environments. Wards with blind spots had mirrors installed to help staff with observation. Each ward had a ligature risk assessment and staff mitigated any identified risks through individual patient risk assessments and observation.
  • All clinical staff carried mobile alarms that enabled them to respond to emergency calls for assistance when required.
  • Staff completed standard and specialist risk assessments with patients and updated them regularly. The provider reviewed its restrictive practices regularly and made changes, where appropriate.
  • The hospital had the appropriate emergency equipment. Medicines were stored safely and checked regularly. Staff completed prescription charts fully and accurately.
  • The provider had a visiting policy and safe procedures for children and families who visited the hospital. The hospital had a designated visitors’ area away from the wards.
  • Staff reported incidents appropriately and managers analysed incidents to identify any patterns and trends and gave staff feedback on any lessons learnt.

However:

  • Staff did not always record the time of the physical observations that they completed after they gave oral medication for the purposes of rapid tranquillisation.
  • There were different processes for recording physical observations on the wards.
  • The provider’s rapid tranquillisation policy lacked guidance on monitoring physical observations after oral rapid tranquillisation.

Effective

Good

Updated 18 May 2017

We rated effective as good because:

  • All patients received timely and comprehensive assessments of their mental and physical health needs. Patients had up-to-date, recovery-oriented care plans based on ‘my shared pathway’.

  • The hospital showed a strong commitment to reducing the use of antipsychotic drugs. Five patients did not take any psychotropic medication. Where patients used medication, they were on low doses.

  • The hospital had access to a wide range of disciplines that provided input to the wards and patients. All wards had regular, effective and well-coordinated multidisciplinary team meetings and handovers.

  • Staff received supervision and annual appraisals. Staff had access to a range of forums that supported clinical practice and encouraged learning and development.

  • Mental Health Act (MHA) documentation was up-to-date and completed accurately. There were effective systems and processes in place to ensure compliance and good practice with MHA requirements.

  • Most staff had a good understanding of the principles underpinning the Mental Capacity Act (MCA). The hospital applied the MCA appropriately and followed best interests processes for significant decisions, where necessary.

  • Staff completed a range of clinical audits regularly from which they identified any issues and made the appropriate changes.

  • The hospital addressed poor staff performance promptly and effectively, and in line with the provider’s policies and procedures.

However:

  • Not all staff supporting the wards for people with autism had received training in autism.

Caring

Good

Updated 18 May 2017

We rated caring as good because:

  • We observed good interactions between staff and patients throughout the hospital.

  • Staff knew the patients well and responded to their needs appropriately and sensitively.

  • All patients had a transition plan before admission that included visiting the hospital and meeting the staff, and received a welcome pack on admission.

  • Patients and their relatives, where appropriate, were involved in assessment and care planning. Patients received copies of their care plans.

  • Patients had access to advocacy services.

  • Most wards had regular community or house meetings at which patients could raise any issues and concerns.

Responsive

Good

Updated 18 May 2017

We rated responsive as good because:

  • The hospital had ample secure outdoor space and a range of facilities that promoted recovery and comfort.

  • The wards for patients with autism had autism-friendly environments and some had facilities such as sensory rooms.

  • We saw examples of recovery-focused progress made by patients in both core services.

  • Staff made adjustments to meet the specific needs of patients with learning disabilities or autism including easy-read or picture-based information and orientation aids and signage on the wards.

  • Patients on the wards had access to a choice of food based on their individual needs and preferences. Patients who lived in the cottages planned and cooked their own meals.

  • Staff actively supported patients to develop their independent living skills as part of their recovery-based rehabilitation.

  • The newly refurbished occupational therapy suite contained a range of facilities that supported recovery-based activities and rehabilitation.

  • Patients knew how to complain and staff took their complaints seriously.

However:

  • Staff and patients complained about the temporary reduction in activities onsite while the occupational therapy suite underwent refurbishment.

  • There was an absence of robust data on patients’ activities.

Well-led

Good

Updated 18 May 2017

We rated well led as good because:

  • Since our last inspection, the hospital had made changes to the leadership structure and developed two clear service pathways (forensic/secure inpatient and learning disability and autism).

  • The provider had improved its governance systems and processes for monitoring all aspects of care. For example, it had implemented a programme of audits and had robust incident monitoring processes.

  • Managers and staff had access to information that helped them assess service delivery and identify areas for improvement.

  • The provider showed commitment to developing autism-focused care. The provider had recruited a specialist psychiatrist and started to offer staff specialist training for their roles.

  • The hospital manager had sufficient authority and support to manage the wards effectively, suggest improvements and implement changes to the service.

  • The hospital had a risk register that set out risks to the business and service delivery.

However:

  • Staff morale varied between the wards and teams and some staff showed a poor understanding of the hospital’s vision and values associated with recovery-based care and least restrictive practices.

  • The hospital did not have an allocated clinical lead role allocated to infection prevention and control.

Checks on specific services

Wards for people with a learning disability or autism

Good

Updated 28 December 2017

Forensic inpatient or secure wards

Good

Updated 18 May 2017