Windermere House Independent Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question as good. At this assessment the rating has remained good with evidence of outstanding practice in the kindness, compassion and dignity quality statement. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

During this inspection we collected evidence from staff, carers and patients where possible. We completed observations of staff interactions and the running of the ward. Staff were exceptionally compassionate, caring and understood the importance of person centred and individualised care.

Staff went over and above in their care of patients and we observed this during the inspection, where staff treated patients receiving end of life care as they would treat a member of their own family.

The service made arrangements to support family visits, including supporting a patient to go shopping in the community to buy food, supporting them to cook two meals and set up a room for the patient and their wife to enjoy an anniversary meal, giving them a sense of accomplishment. The ward ensured children had a safe space and garden area to visit their family. The level of care and empathy demonstrated during our inspection was to the highest standard and this was reflected during conversations with relatives.

This service scored 80 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During the inspection we completed a Short Observational Framework for Inspection (SOFI) it was identified that there was a strong culture of care and compassion towards patients. Interactions between staff and patients were positive. We observed staff of all roles demonstrate kindness, empathy and compassion. Staff evidenced high level knowledge and use of de-escalation techniques when patients were distressed. Staff knew patients' needs well and were able to tailor responses to distress to meet the needs of the patients in a efficient, effective and discreet manner to avoid further escalation. On reviewing patients positive behaviour support plans, it was evident that staff were well versed in the content of these plans.

The service appropriately assessed patients to determine which ward would suit their needs better. Staff were able to transfer patients from Coniston ward to Kendal ward if needs were better met within this environment and patient group. Patient surveys told us that patients felt staff were kind and caring. Staff we spoke to were compassionate about the care they deliver to patients and this was evident in their observed approaches.

We spoke to a patient on Coniston ward who told us "the staff are really nice, they do their job well. They're always there if I need food, drink, someone to talk to, a light, or some towels. The staff are really nice, they do their job well. They're always there if I need food, drink, someone to talk to, a light, or some towels. The staff asked me personal preferences in my care plan."

Staff made adjustments to suit the needs of the patients. This included specialised equipment in form of chairs and seating. There were boards within patient's bedrooms which outlined how to improve that persons day and what they enjoyed doing on the ward. This enabled staff to ensure they provided meaningful, person centred activities for patients. Patients had access to 1:1 engagement with their key nurse and this was evidenced within care records, during these engagement sessions staff took into account patients individual needs, their own voice and planned individual goals.

Within care records, patients had evidence of nutritional and hydration needs, which included any plans around dietary requirements for individual patients. Patient's physical health was monitored routinely and amended if requiring more intensive observation. Patients also had access to the local church and the vicar completed visits to the ward to offer spiritual support to patients. The ward told us they were able to reach out to various links to accommodate people's religious needs.

Staff utilised technology to help communicate better with a patient whose first language was not English. Staff made efforts to find out about the person's culture to help them feel included and engaged.

Patients had positive behaviour support plans in place which outlined ways to maximise their independence, choice, and control and how staff could support them to do so. Staff encouraged patients on Coniston ward to attend their multidisciplinary team meetings to provide feedback and share their views on their care and this was supported by carers we spoke to who felt included and listened to during these meetings.

There were information boards on the ward which identified activities available, groups that had planned activities into the community, advocacy services and local services in the area. Patients could provide feedback using a suggestions box and the ward had a poster in place for a patient representative. We spoke to 6 carers who all felt that the care received ensured their relatives maintained their independence as much as possible and had a voice within their care and treatment.

The service listened to and understood people's needs, views and wishes. They responded to these in that moment and acted to minimise any discomfort, concern or distress.

Care records showed that a number of nationally recognised tools were used to enable staff to respond to any specific risks, including falls, pressure ulcers and changing needs. Tools included the Waterlow Scoring (The Waterlow Score, is widely used risk assessment tool in the UK, plays a vital role in identifying and managing pressure ulcer risk), Grist Risk Assessment tool (a risk assessment tool that is recommended in best practice guidelines) and NEWS (National Early Warning Score) tool, which identified deteriorating physical health. Care records evidence regular use of these tools to monitor patient need.

Staff were able to recognise and respond to changes in patients behaviour and 95.56 % (43 out of 45) of staff across the hospital had completed their training in management of aggression. The level of knowledge staff held in de-escalation and recognising patient needs was reflected in the 0 uses of rapid tranquilisation and minimal level of restraint. The ward did not use any prone (face down) or supine (face up on floor) restraints.

During our inspection we witnessed staff respond immediately to the physical deterioration of a patient. Staff were very quickly able to recognise signs of the person becoming unwell and were able to support them in a caring and dignified way, escalating the situation appropriately.

Staff were able to demonstrate understanding around assessing the need and changing needs of patients and responding to appropriately. During our inspection we observed staff respond to a medical emergency, identifying, acting and ensuring compassionate care and treatment. Staff told us they continually assessed any signs of agitation, responding to unseen stimuli, changes to risk levels or warning signs that a patient might need further support. This information was documented within care plans, risk assessments and positive behaviour support plans. We observed a further interaction of a distressed and confused patient in which staff utilised calm verbal de-escalation, evidencing they knew the patients needs well.

We spoke to 11 members of staff who work across Coniston ward and Kendal ward. The majority of staff we spoke to had worked within the service and Coniston ward for many years, which evidenced good staff retention. The range of time spent working in the service was from 2 years to 22 years. Staff told us that the management team were supportive and they felt they could raise any concerns. Staff were aware of the freedom to speak up champion and that they would utilise this route if they felt necessary.

Staff we spoke with told us of additional staffing pressures at times, data we reviewed did not show evidence of any unfilled shifts. Staff said that local management are supportive and responsive but were sometimes prevented by making changes to areas such as staffing levels by organisational policies.

Another member of staff told us that management visible and present on the ward. Staff we spoke with told us that morale feels good, although some days are more pressured than others. Staff told us "It's very good working here. It gives me satisfaction and people value what we do. For all the years, managers have come and gone, I've always been valued. It is the power of team work here and there is nothing that we can't achieve".

We reviewed sickness levels across the hospital for the last year. Both short term and long-term sickness levels remained very low, within the last 6 months short term sickness being at 2.7% and long term sickness at 2.3%. Data showed that 94.92 % of staff had completed their monthly supervision and 91.67 % had completed their annual appraisal.