Windermere House Independent Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people's care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good.

There were processes and pathways to ensure effective discharges and regular physical health monitoring in place. There were regular activities provided by staff to engage patients and individual plans to support people.

Patients had comprehensive mental health assessments completed on or soon after admission.

This meant people's outcomes were consistently good, and people's feedback confirmed this. Staff assessed patients in a person-centred way and included them as partners in their care and treatment. Staff worked well as a multidisciplinary team to deliver care and treatment. Staff had good knowledge around the MHA, MCA and Deprivation of Liberty Safeguards and knew the difference between these.

Patients had access to a wide range of specialists, including psychologists, occupational therapists, nurses, healthcare assistants and psychiatrists. Staff supported patients in accessing physical healthcare specialists such as podiatrists, GPs, opticians, dentists and speech and language therapists.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients outcomes were consistently good and staff and carers feedback confirmed this. Patients’ needs were assessed in a holistic and person-centred way and there was a multidisciplinary approach to delivering care and treatment. We reviewed 5 care records of patients on Coniston ward. This included admission documents, care plans, risk assessments, positive behaviour support plans and the monitoring tools used to assess effectiveness of treatment. We found that all care records were regularly reviewed. Care files were comprehensive and accessible, with relevant documentation being easy to locate for staff. Care records included admission observations, evidenced regular physical health reviews and contact with external partners such as GP’s, dentists, physiotherapists, advocates and social workers. Care records were patient centred with clear discharge goals, ongoing assessment of needs and abilities and utilised recognised tools for monitoring outcomes. Where patients were unable to give their personal preferences or input, family members were included in the care planning and regular MDT meetings.

Staff understood the importance of monitoring patients hydration and nutritional needs.

We saw evidence that people's needs were met in line with current guidance and best practice. We reviewed care plans which referenced the Mental Health Act and Mental Capacity Act where applicable. Restrictions and blanket restrictions were regularly reviewed to maximise independence and based on risk reviews and environmental checks. Restrictions that were in place were recorded within the blanket restrictions risk register. Coniston ward also utilised recognised and evidenced based tools such as the Independent Living Star (a tool used to monitor and rate abilities to determine level of support needed).

Coniston ward had offers of various activities to engage patients and add fulfilment. Some activities on offer included, cookery sessions, art therapy, yoga sessions and a `pop up pub' in which discussions as a community could take place. Staff facilitated this to encourage engagement and activity. There were weekly community meetings and Coniston ward ensured people had access to activities and local community groups which were discussed in these meetings. As part of these meetings, the ward reviewed "You said, we did" and fed back to patients on improvements from their suggestions.

Staff provided a range of care and treatment interventions suitable for the patients on Coniston and offered activities, training and work related qualifications from Asdan (nationally approved qualifications based around the development of personal, social and employability skills) intended to help patients acquire living skills. Staff ensured that patients had good access to physical healthcare and regular physical health checks were evidenced within patients care records, including partnership notes regarding dental appointments and routine physical health checks with the GP. Regular one-to-one nursing reviews were used to review patient's progress.

We reviewed the levels of supervision that staff received over the last three months and this showed a percentage of 94.92 % (56 out of 59 staff). We also reviewed staff's annual appraisals which were 91.67 % (44 out of 48 staff). Staff told us that they had opportunities to seek additional training relevant to their roles and opportunities to develop their knowledge. This was also evidenced within the Development Directory.

We observed a morning meeting, including handover documentation, minutes of staff meetings and multidisciplinary team (MDT) minutes. We found that teams worked well to support patients on Coniston ward and included families. Care records evidenced regular contact with physical health services, social workers and other allied health professionals involved in their care. The handover meetings observed showed that staff discussed previous actions and what had been completed. Teams also discussed staffing gaps and needs and maintenance staff also attended morning meetings and gave updates of ongoing work/new requests from staff for improvements.

We observed that ward activities helped promote a healthy lifestyle for patients on Coniston ward. Staff encouraged patients to attend various ward based groups such as Staying Strong Group, which helped promote healthy coping mechanisms, encouraging patients with gardening, the ward also took part in the ‘Hull to Lapland Challenge’ to encourage movement and physical activity for walking. The ward ensured that activities were accessible for the patients on Coniston ward and tailored community visits to suit patient need. In the month prior to our inspection, patients were supported to have trips to Spurn Point, Hessle Foreshore, and local garden centres. The ward ensured that food choices were wide ranging and healthy options were always available. Staff also supported patients to physical health appointments and kept records of contact with GP’s and incorporated physical health needs into care plans. The ward worked to ensure that patients with disabilities were receiving the correct care and liaised well with community district nursing teams.

Coniston ward used audits to monitor and improve outcomes for patients. Audits were in place to review number of incidents and any use of restraint, which also was monitored by the Restrictive Practice Group within Barchester. Blanket restrictions were regularly reviewed to ensure least restrictive practice and restrictions were discussed with senior leaders during regional audits. The ward also undertook patient surveys which on review were all positive. The ward also completed monthly ‘lessons learned’ meetings in order to look at what actions could be taken to improve outcomes.

The ward used recognised national rating skills such as Recovery Star, Independent Living Star and risk assessment tools. Risk assessments were all within date and evidenced regular reviews to recognise changing risks which were reflected in Positive Behaviour Support plans. The ward also had a Safety Incident Response Framework Policy (SIRF Policy)in order to review any incidents and prevent future recurrences.

Staff recognised patient’s achievements during their admissions and gave recognition to these.

We reviewed 5 care records of patients on Coniston ward and all care records evidenced that patients had their rights under the Mental Health Act communicated to them. 100% of staff had received training in the Mental Health Act at the time of our inspection and during interviews, staff were able to demonstrate knowledge and understanding of the difference between the Mental Capacity Act and Mental Health Act. All care records had evidence that consent to share information with carers had been clearly documented. All patients on Coniston had regular and consistent visits with an independent mental health advocate who had no concerns at the time of our inspection. Where people were nursed under the mental capacity act, best interest decisions that were decision specific were documented, discussed in MDT's and communicated through care plans.