Windermere House Independent Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people's needs. At our last assessment we rated this key question as good. At this assessment the rating has remained as good. This meant people's needs were met through good organisation and delivery.

The service was tailored to meet the specific needs of patients. Discharge planning commenced upon admission and there was a multidisciplinary approach to planning transitions between services. Care was person centred, and staff listened to carers to form collaborative care and treatment plans in line with the patients' preferences and taking into account personal history. Staff made efforts to explain treatment to patients and carers were given information to help them make informed decisions.

Bed capacity was well managed and there was good oversight of number of patients and beds available. Where discharges were delayed, this was due to provision within the community and the need for specialist placements for patients to step down into. There was no evidence discharges were delayed due to clinical reasons.

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.

Coniston ward patients were involved in the decoration of the ward itself and encouraged to personalise both communal areas and their individual bedroom space. Patients had been involved in creating murals within the corridor spaces and communal lounges. Bedrooms had photographs of family and friends and patients had personal possessions from home. All bedrooms had en-suite bathrooms with a toilet and sink. The bath and shower were located in a space on the bedroom corridor. In each bedroom there were Good Day/Bad Day posters which were person centred around what they enjoy each day or what might make the day more difficult. The ward environment offered lower stimulus areas, lounges that also be used as space for activities.

Staff had one to one engagement with patients and this was reflected within their care records. Care records showed that one to one engagement was taking place regularly and in line with policy. Personal Behaviour Support Plans were detailed and included personal history, preferences and dislikes which made them individualistic.

We completed SOFI observations throughout the inspections which demonstrated staff delivering person centred care, reflective of needs and care plans.

Coniston ward offered Asdan courses to all patients. These courses are designed to help promote patients independence and living skills through various activities. When patients had completed courses staff celebrated this and recognition to patients was given. The ward held graduation sessions and this was well received by patients, staff and carers. The ward also encouraged patients to attend a ‘pop up pub’ which was held in the activity room between the two wards. This encouraged patients to spend time with others, where meaningful conversations could happen in a relaxed and normalised environment. The pop up pub event took place during our inspection and patients attended in groups to play dominoes and enjoy refreshments.

Coniston staff supported families to maintain contact with patients and accommodated visits for carers and family members. One patient was supported by staff to budget, go shopping in the community and prepare and cook a meal with support of occupational therapists to cook a meal for he and his wife’s anniversary. Care provision was goal specific, meaningful to patients and integrated family and carers into the process.

During inspection we noted that CQC posters with ratings were displayed throughout the hospital for patients and visitors to see. There were processes in place for Coniston ward to submit notifications (Registered providers must notify us about certain changes, events and incidents that affect their service or the people who use it) to the CQC. There were record systems in place that were safely and securely stored. The hospital was going through changes to information and record keeping, moving to an online format as opposed to paper copies. At the time of inspection, this was still paper records. Kendal ward audited records to ensure there were no gaps in record keeping, Mental Health Act documentation or Deprivation of Liberty authorisations.

We observed information posters relating to hospital admission in the visiting area's for carers and relatives. This included information about the service, how to raise complaints, how to give feedback and advocacy details. There were various forms of information available, including larger print, easy read and different languages if required. This information also informed patients of their right to leave if admitted informally to the service.

Care records showed that regular contact with other professionals involved in patients care was documented so communication was maintained throughout the patient's admission. Staff bulletins were regularly produced and the `life enrichment' bulletin for June (published day before our site visit) was printed off and shared on tables. This included updates from other sites in the Barchester group.

Coniston ward had information available on how people could complain, or raise concerns on the ward, it contained contact details for the ward advocate. There was access to easy read information and upon speaking to carers, they were also aware of how they could raise complaints if needed. There were also ‘feedback and suggestion’ posters indicating how people could provide the ward with feedback. We reviewed data from the last year and of 46 responses received, 11 were complaints and 34 were positive feedback. One was marked as ‘other’. At the time of our inspection, there were no ongoing or open complaints.

Within complaints raised, there were no identified reoccurring themes. Some complaints referred to the ward environment, which were able to be addressed quickly by maintenance. Ongoing work was being completed to improve the speed of wifi within the hospital as this had been noted as a complaint. This was being carried out during our inspection. Patients had raised that the garden furniture needed updating, this had also been purchased and awaiting delivery.

Carer feedback was positive in terms of people knowing how to raise complaints, some carers stated they have never needed to. Others felt listened to and reassured by the responses provided by staff. The ward undertook monthly lessons learned meetings to ensure learning from any complaints, incidents or adverse events.

There was a clear referral process into Coniston Ward. Referrals mainly came from the integrated care board (ICB), other providers/hospitals and care settings. There was flexibility within the hospital for patients to move from Coniston to Kendal ward if felt needs were better met. Staff ensured the needs of patients with mobility issues were addressed and made reasonable adjustments, involving physiotherapy for advice on specific equipment required to enhance care. The ward is situated on ground level enabling access for wheelchair users and the garden areas were accessible. There was appropriate staffing within the MDT and at the time of inspection there was ongoing onboarding of a full time psychologist and occupational therapist. There was a consultant psychiatrist in place who provided weekend cover. There was MDT cover for during the week, including occupational therapist, activity leads and domestic cover.

Appropriate referrals were made when people required additional support and partners were kept informed of progress and discharge planning. This was evidenced within care records and documentation. There was evidence of successful discharges within the last 6 months and patients moving on from hospital. Some admissions had been lengthy and staff told us there can often be challenges with finding suitable placements following discharge.

During this inspection we did not identify any barriers to care, support and treatment. Staff on Coniston ward had regard to the needs of people with different protected characteristics, including those with long term conditions such as dementia and they made reasonable adjustments to support equity in experience and outcomes.

There were policies in place to protect both patients and staff from abuse, including an allocated freedom to speak up champion.

Staff completed mandatory equality and diversity training and at the time of our inspection, training compliance was 100%. Staff also completed training on learning disabilities and autism with training compliance at 100%. Staff were inclusive to both each other and patients alike. The hospital as a whole celebrated Silver Pride, recognising members of the LGBTQ community and this was very well received.

Care records showed continuous discussion around discharge goals and what support and care would be needed to achieve this. Goals were discussed with patients and where appropriate carers and documentation evidenced the patient’s voice.

Staff worked with patients on Coniston ward to ensure smooth transitions into ongoing placements. This included MDT meetings and discussions with both patients and families around goals, preferences, and the needs of the patient to ensure discharge was fully supported and successful. Staff also ensured that any DNAR paperwork went with patients on discharge.