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The WoodHouse Independent Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 August 2021

The WoodHouse Independent Hospital provides services for people with a learning disability or autistic people in a range of small, bespoke units and cottages. The service offers assessment, treatment and rehabilitation placements, individualised and intensive packages of care and step down to community-based services. The service specialises in providing care for autistic people and people with forensic histories.

We most recently carried out a focused responsive inspection at The WoodHouse Independent Hospital in October 2020, but we did not rate the location at this inspection. This meant we did not gather enough information across the whole service to re-rate it due to the specific focus of our inspection.

Following the inspection in October 2020, we issued an urgent Notice of Decision in relation to Regulation 12 regarding infection prevention control measures and placed conditions on the provider’s registration. These conditions were removed in January 2021 after the provider applied to have the conditions removed and supplied evidence to us that infection prevention control practices had improved.

This inspection was carried out to follow up on the concerns identified during our previous inspection as well as respond to new information of concern received about the safety and quality of the services.

We undertook an unannounced focussed inspection of all key questions:

Are services safe?

Are services effective?

Are services caring?

Are services responsive?

Are services well-led?

We visited the location on 8 June 2021 during the day and night shift and again on 9 June 2021 during the day shift.

We did not look at all key lines of enquiry during this inspection. However, the information that we gathered, the significance of the concerns and the impact on people using the service provided enough information to make a judgement about the quality of the care and enabled us to re-rate all key questions.

Our rating of this location stayed the same. We rated it as requires improvement because:


  • People’s care and support was not always provided in a well-furnished and well-maintained environment which did not always meet people’s sensory needs.
  • Not all staff understood how to protect people from abuse. Staff had training on how to recognise and report abuse but did not always know how to apply it
  • The service did not always have sufficient, appropriately skilled staff to meet people’s needs and keep them safe. There was a high use of agency staff who did not always know the people they were supporting. There were not always enough nurses working across the site to support all eight units. Staff continued to not receive their break.
  • Staff continued to not always follow systems and processes to safely prescribe, administer, record and store medicines.
  • Staff did not always report incidents or carry out body maps after incidents of physical intervention.
  • Not all staff working on the female unit Hawksmoor were provided with any additional specific training to support females.
  • Maintenance faults were not always reported appropriately by staff and therefore were not rectified in a timely manner.
  • People did not always receive kind and compassionate care from staff and they did not always understand each person’s individual needs.
  • Staff did not always receive regular supervision and the service had low rates of supervision.
  • Staff did not always maintain contact and share information with those involved in supporting people, as appropriate. Relatives and carers did not always receive timely information and did not feel actively involved in planning their relative’s care.
  • There was not a robust system in place to ensure that staff who were working during the night shift were appropriately undertaking their roles.
  • There were not always enough vehicles or drivers to support section 17 leave.
  • There continued to be a lack of leadership at middle management level. Staff did not have confidence in nurse managers and did not find them approachable. Staff did not feel able to raise concerns without fear of retribution. The process in place for raising concerns was not always adhered to by managers.

However:

  • People had their communication needs met and information was shared in a way that could be understood.
  • People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
  • Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
  • People 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.People were in hospital to receive active, goal-oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support in place they went home.
  • People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.
  • People were supported to be independent and had control over their own lives.

We expect Health and Social Care providers to guarantee people with a learning disability and autistic people 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. The service could not show how they met some of the principles of right support, right care, right culture.

It was clear that there was a need for the service as agreed by commissioners. People were able to access the community for various activities and the service works towards policies and procedures being in line with best practice. Care that was provided to people was person-centred.

However, the setting and design of the service did not always meet people’s sensory needs. For example, we did not find Moneystone unit to be autism friendly. We also found with staff morale, staff cliques and lack of faith in managers, the culture was not always the right culture for people using the service.

We found a mixed culture at the service. We saw evidence that most recovery workers ensured people received person-centred care. However, we also heard about and saw evidence of some people being exposed to inappropriate practices and not always being protected from harm.

There was a lack of leadership at a nurse manager level. Staff were reluctant to raise concerns and when they did, managers failed to respond or act on these concerns. There were some poor relationships within staff groups and it was reported there were cliques among some staff across the service. This led to some staff reporting feeling uncomfortable working on certain units.

Inspection areas

Safe

Inadequate

Updated 27 August 2021

Effective

Requires improvement

Updated 27 August 2021

Caring

Requires improvement

Updated 27 August 2021

Responsive

Good

Updated 27 August 2021

Well-led

Requires improvement

Updated 27 August 2021

Checks on specific services

Wards for people with a learning disability or autism

Requires improvement

Updated 27 August 2021

The summary is contained in the overall summary at the beginning of the report. Our rating of this service stayed the same.