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Turning Point - Douglas House Outstanding


Inspection carried out on 7, 8 and 18 March 2016

During a routine inspection

We rated Turning Point - Douglas House as outstanding because:

  • There were strong, person centred clinical leadership and governance arrangements, led by a well-respected registered manager. The manager clearly articulated the changes they had made to the hospital through listening to staff, patients and other stakeholders. This was complemented by a comprehensive range of audits which were fully completed to continuously drive improvement. The manager had clearly articulated positive changes following audit.
  • Patients and staff worked in true partnership as equal partners with a focus on recovery principles and shared decision making. Managers were looking to consolidate this through adopting the ‘implementing recovery through organisational change’ programme. The service involved patients in a range of ways and at all levels from involvement in their own individual care goals through to involvement in the hospital through to commenting on Turning Point’s national policy and campaigning work. This was exemplified by the manager who encouraged patient representatives to be fully involved in the presentation made to the CQC inspection team.

We also saw:

  • Staff carried out thorough risk assessments on patients to ensure they could be cared for in a rehabilitation environment. The hospital manager took immediate and significant action to address the washing arrangements in one bedroom so that it fully complied with same sex guidance. The hospital had minimal incidents but when these occurred staff took appropriate action to address them and learn lessons.
  • The hospital was recovery focused with care and support plans developed from the mental health recovery star tool. Patients received multidisciplinary input from a range of staff which included an occupational therapist, an arts therapist and assistant psychologist. Staff provided enthusiastic and individualised support to patients over daily tasks such as planning and shopping for meals, cooking and tidying. There were good systems in place to support adherence to the Mental Health Act (MHA).The MHA co-ordinator attended ward rounds on a weekly basis to promote adherence to the MHA.
  • Staff engaged with the local city-wide review team to discuss and co-ordinate the admission of all patients into rehabilitation beds across Manchester. The hospital started planning for patient discharge from when patients were first admitted. There was a small outreach team to work with patients on discharge if they needed ongoing proactive support. There had been no complaints at Douglas House for the last 12 months.

However we also found that:

  • The medical input to patients provided by the local mental health trust was not covered by a written service level agreement that clearly outlined the rights and responsibilities of each party and the appropriate local escalation and resolution if any matters of concern were raised by either party.

Inspection carried out on 22 July 2013

During a routine inspection

The people we spoke with were very positive about the way they were supported. People told us they were involved in developing all aspects of their care plan and they were always asked to give their consent to treatment. People who used the service described Douglas House as �a nice place� and one person said, �Its good here, I love it�. Another person told us, �I feel involved in all my care plans.�

The Mental Health Act Commissioner looked at the Mental Health Act paperwork to check that people's rights were protected. They confirmed that the correct paperwork was in place and systems and checks were in place which ensured staff were meeting their responsibilities under the Mental Health Act.

Staff were trained on how to safeguard people from abuse and harm and they knew to report any signs or the suspicion of abuse to a member of staff immediately.

The people who used the service said the staff were always friendly and supportive. They confirmed they had never been treated badly. One person commented on the calm atmosphere in the hospital. They said, "This helps me deal with things that are going on for me."

A complaint procedure was displayed in the public hallway so the people who used the service had information about what to do if they were unhappy with the standard of the service they received.

Since the last inspection, improvements had been made to the records kept about the people who used the service.

Inspection carried out on 5 March 2013

During a routine inspection

The people who used the service said they were happy with the care and support they received. They spoke highly of the staff team and told us staff listened to them and supported them. People told us they were involved in developing their care. Their comments included:

�When the consultant wanted to add another medication to my treatment, he explained why and that I would need weekly blood tests. He also explained how he felt this would help me. I never felt pressured to agree with him and he gave me lots of time to ask questions and to discuss any areas of concern.�

�The staff encourage me to think for myself and that matters a great deal to me.�

�The staff never abuse their power.�

�The staff are always there for you.�

One person told us they would feel comfortable raising any concerns with the manager. They said, �The manager is really nice and I know she will listen.�

During an inspection to make sure that the improvements required had been made

This was a follow up review to check that the service had put actions in place to address minor concerns. We did not speak to any people who use services during this review.

Inspection carried out on 22 September 2011

During a routine inspection

People who use services were generally positive about the care they received at Douglas House. They told us they were involved in their care. They said that they felt staff listened to them and supported them. One person said they could not think of anything they would change at the hospital. People who use services said they met with their key workers regularly to discuss their care. Comments included 'It's lovely here', 'They treat you with a lot of respect'.

Reports under our old system of regulation (including those from before CQC was created)

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.