You are here

The WoodHouse Independent Hospital Inadequate

We are carrying out a review of quality at The WoodHouse Independent Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 3 September 2019

We rated The Woodhouse Independent Hospital as inadequate because:

  • The hospital was not adequately staffed. Nearly 90% of the establishment ward staff posts were unqualified support workers and 40% of posts for both nurses and support workers were vacant. As a result, unqualified agency staff covered a high number of shifts. This included most of the night shifts. Some of the agency staff were new to the hospital and did not know the patients. This meant that the care plans and positive behaviour support plans developed by the specialist staff were not always enacted by the ward-based staff – some of whom told us that they had not read the plans. Also, the staffing situation meant that a qualified nurse was not always present in communal areas of the ward, that staff were often unable to take rest breaks or regular breaks from enhanced observations, that escorted leave was often cancelled for patients on general observations and that patients did not have regular one-to-one time with their named nurse.
  • Managers did not provide staff with the induction, training, supervision or appraisal that would have mitigated the staff’s lack of qualifications and specialist skills required to provide high quality care to people with such complex needs.
  • The service was not well led at ward level and there was a lack of resource at all levels of leadership. The governance processes did not operate effectively at ward level meaning that performance and risk were not managed well. Clinical and internal audit processes did not have a positive impact on quality governance. There was no structured induction programme for agency staff. Staff were not supported through appraisals and regular supervision to enable them to carry out the duties they were employed to perform. There were no regular team meetings for staff to discuss clinical concerns and learning as a team with managers.
  • Staff did not always follow systems and processes to safely store and manage medicines. Learning from incidents was not discussed with staff. Managers did not always debrief and support staff after serious incidents.
  • The ligature risk assessments lacked clear actions on how the risk was managed. There was no emergency drug (Adrenaline) available to treat anaphylaxis. The checks were not always reliable and valid.
  • Staff did not monitor the physical health of patients consistently. Care plans did not always reflect the assessed needs of patients. They were not always personalised, holistic and recovery-oriented nor always updated in a timely manner. Staff did not participate in clinical audits, benchmarking and quality improvement initiatives.
  • Staff did not always assess and record capacity to consent clearly where patients might have impaired mental capacity. Staff did not know their identified lead for the Mental Capacity Act.
  • There was no sensory room within the hospital to meet the needs of patients who would benefit. Quiet areas on some wards were not available to allow patients an opportunity to avoid noise and disruption. Managers did not regularly review the mix of patients on the wards to ensure the environment was comfortable for all patients.
  • The provider had not carried out an autism friendly assessment to ensure that the environment was suitable for patients with autism. The service did not ensure that the needs of patients with specific communication needs were met.

However:

  • Staff understood how to safeguard patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • Staff regularly reviewed the effects of medications on each patient’s physical health. They knew about and worked towards achieving the aims of the STOMP programme (stop over-medicating people with learning disabilities).
  • We observed staff treating patients with compassion and kindness. They respected patients’ privacy and dignity. The multidisciplinary team involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided.
  • Staff planned and managed discharge well. Staff helped patients with advocacy, cultural and spiritual support.
Inspection areas

Safe

Requires improvement

Updated 3 September 2019

We rated safe as requires improvement because:

  • The hospital was not adequately staffed. Forty percent of posts for nurses and support workers were vacant. As a result, agency staff covered a high number of shifts. This included most of the night shifts. Three wards ran entirely on agency staff. Some of the agency staff were new to the hospital and did not know the patients. This was something that patients were concerned about. Those agency staff that had worked shifts at the hospital for some time were moved to work on different wards each shift. This adversely affected continuity of care. The way that staffing was managed meant that a qualified nurse was not always present in communal areas of the ward, that staff were often unable to take rest breaks or regular breaks from enhanced observations, that escorted leave was often cancelled for patients on general observations and that patients did not have regular one-to-one time with their named nurse.
  • The service had not done all it could to minimise the use of physical restraint. Although the positive behaviour support plans described actions that staff could take before resorting to restraint, some staff told us that they had not read the plans and other staff were new to the wards and did not know the patients. Also, only senior managers understood and participated in the provider’s restrictive interventions reduction programme. They had not promoted awareness of the programme among ward staff to ensure that they understood the meaning of restrictive practice, its impact and how to minimise the use of restrictive interventions.
  • Staff did not always mitigate the risks to patient safety posed by the ward environment. The ligature risk assessments lacked clear actions on how the risk identified was to be managed. Lockwood ward had no ligature risk assessment available. Mangers did not share copies of the ligature risk assessments with staff.
  • Staff did not always follow systems and processes to safely store and manage medicines. Also, the resuscitation emergency bags to treat anaphylaxis did not contain the drug (Adrenaline) routinely used in the hospital to treat the potential adverse reaction to injectable medicines. The checks to monitor the emergency bags were not always reliable and valid.
  • Managers did not discuss learning derived for the investigation of incidents with staff. Managers and staff were not aware of the Learning from Deaths Mortality Review (LeDeR) Programme. Managers did not always offer staff debrief and support after serious incidents.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • All of the provider’s own staff had easy access to clinical information and it was easy for them to maintain high quality clinical records.
  • Staff regularly reviewed the effects of medications on each patient’s physical health. They knew about and worked towards achieving the aims of the STOMP programme (stop over-medicating people with learning disabilities).
  • However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • All of the provider’s own staff had easy access to clinical information and it was easy for them to maintain high quality clinical records.
  • Staff regularly reviewed the effects of medications on each patient’s physical health. They knew about and worked towards achieving the aims of the STOMP programme (stop over-medicating people with learning disabilities).

Effective

Inadequate

Updated 3 September 2019

We rated effective as inadequate because:

  • A high proportion of staff working on the wards lacked the skills, training and experience to support the complex needs of, and provide high quality care to, patients with learning disabilities or autism. A high proportion of ward staff were agency staff and managers had not provided them with the induction, training or clinical supervision that would mitigate their lack of professional training. Also, they had not provided training or leadership development opportunities to ward managers.
  • As a result of the staffing situation, ward staff were not always aware of or following the care plans developed by the specialist staff.
  • Staff did not have time to fully familiarise themselves with care plans and positive behaviour support plans on wards to use the information in practice.
  • Managers did not ensure that staff attended regular team meetings on wards.

  • Staff did not consistently monitor physical health. Records reviewed showed that 35% of patients had no hospital passport in place or it was not fully completed with the important information required.
  • Care plans did not always reflect the assessed needs and were not always personalised, holistic and recovery-oriented and at times not updated in a timely manner.
  • Staff did not participate in clinical audits, benchmarking and quality improvement initiatives.
  • Staff did not always assess and record capacity to consent clearly each time a patient needed to make an important decision where they might have impaired mental capacity.
  • Staff did not know their identified lead for the Mental Capacity Act and were not sure where to get advice on Mental Capacity Act.

However:

  • The specialist staff developed care plans that were appropriate for the patient group and consistent with national guidance on best practice. However, many of the front-line staff did not have the skills to enact these plans.
  • Staff assessed the physical and mental health of all patients on admission, ensured that patients with known problems had access to physical healthcare and supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes.
  • The service had good working relationships with staff from services that would provide aftercare following the patient’s discharge and engaged with them early on in the patient’s admission to plan discharge.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.

Caring

Requires improvement

Updated 3 September 2019

We rated caring as requires improvement because:

  • Agency staff who were not familiar with the patients did not have the knowledge or skills to use appropriate communication methods to support patients to understand and manage their own care, treatment or condition. This included finding effective ways to communicate with patients with communication difficulties.
  • Although regular staff understood and supported the individual needs of patients, a significant proportion of ward staff were unfamiliar with the patients and their care plans and therefore could not support patients effectively to meet their needs.
  • Families and carers were not provided with information or signposted on how to access carer’s assessment.

However:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity.
  • The multidisciplinary team involved patients in care planning discussions and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • The service invited families and carers to attend care planning and multidisciplinary team discussions.

Responsive

Requires improvement

Updated 3 September 2019

We rated responsive as requires improvement because:

  • The provider had not carried out an autism friendly assessment to ensure that the environment was therapeutic for patients with autism. The managers had not considered the possible mix of sensory needs of patients living in the same ward.
  • There was no sensory room across the hospital to meet the needs of patients.
  • There were no quiet areas on some wards. Staff did not review the patient dynamics adequately and regularly to ensure the environment was comfortable for all patients.
  • The service had made suitable adjustments for disabled patients to access all the units except one of the cottages. There were no adjustments made for visitors to access the main reception area.
  • The service did not ensure that the needs of patients with specific communication needs were met.
  • There was no clear learning from complaints shared with staff. Staff did not receive feedback on the outcome of investigations of complaints.

However:

  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. Discharge was rarely delayed for other than a clinical reason.
  • Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe.
  • The food was of a good quality and patients could make hot drinks and snacks at any time.
  • Staff helped patients with advocacy and cultural and spiritual support.
  • When patients complained or raised concerns, they received feedback.

Well-led

Inadequate

Updated 3 September 2019

We rated well-led as inadequate because:

  • The service was not well led at ward level and there was a lack of resources at all leadership levels.
  • There was a disconnect between the senior leadership and what was happening at ward level.
  • Our findings from the other key questions demonstrated that governance processes did not operate effectively at ward level and that performance and risk were not managed well.
  • Clinical and internal audit processes did not function well and did not have a positive impact on quality governance.
  • There was no active strategy to consistently promote equality and diversity in day to day work.
  • Staff did not engage actively in local and national quality improvement activities.

However:

  • The hospital director clearly understood most of the areas that required improvement and had come up with an improvement action plan to address these areas. There was lack of enough leaders with knowledge and experience to give adequate support. The hospital director was visible in the service and approachable for patients and staff.
  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Most staff felt respected, supported and valued. All staff felt able to raise concerns without fear of retribution.

Checks on specific services

Wards for people with a learning disability or autism

Inadequate

Updated 3 September 2019

Forensic inpatient or secure wards

Good

Updated 18 May 2017