Windermere House Independent Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as good. At this assessment the rating has remained as good.

Staff ensured patients were safe and protected from avoidable harm. The ward provided a therapeutic and safe environment for older people which met the needs of the service group. Staff involved patients where possible and their relatives in developing and reviewing their risk assessments and risk management plans.

There were enough skilled and trained staff to meet patients’ needs and keep people safe. Staff knew how and when to report incidents and leaders shared learning with the staff team and patients in both team meetings and community patient meetings. Staff knew what their responsibilities were under duty of candour. Staff ensured that there were safe and effective systems in place in relation to medication management.

There was low use of restraint and no episodes of rapid tranquilisation and staff only utilised restraint as a last resort in line with national guidance.

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.

The service had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events were investigated and reported thoroughly, and lessons were learned to continually identify and embed good practices.

We reviewed a sample of 30 incidents over a 3 month period and saw that staff knew what to report and how to report them. The incidents were detailed with clear actions in place. We saw that more incidents had occurred on Coniston Ward than on Kendal ward, in discussions with staff, this was due to the presentation of patients admitted to Coniston ward. Self-harm incidents were noted but there were no identified themes or trends reoccurring.

Staff and patients received debriefs following incidents. Staff met regularly to discuss incidents during handover/ team meetings. There was evidence that staff and leaders complied with duty of candour when reporting incidents and lessons learned.

Staff and managers had good oversight of incidents within the service and carried out monthly lessons learned meetings and improvements made to prevent any future incidents.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. During inspection 5 patient care records were reviewed from Coniston Ward. All records reviewed included comprehensive pre-admission assessments to determine whether the service could provide safe and effective care. These included baseline physical health observations and handover of physical health issues.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Care records included a comprehensive list of partners in care (a list of health and social care professionals already involved with the person). We also found all patients admitted to the ward were referred to an independent mental health advocate (IMHA). This was also confirmed by the IMHA during interview with inspectors. There was clear evidence of discharge planning and provisional dates. MDT discussions also confirmed that discharge planning was central to patients care and treatment. Discharge summaries for Coniston Ward showed that discharges were successful with patients stepping down in care or transferring to a more appropriate setting.

The service had a safeguarding policy in place which was accessible to staff. This policy was underpinned by the 6 key principles outlined in the Care Act. Staff training for Safeguarding at the time of our inspection was 96.61 % (57 out of 59 staff). Equality and diversity training was at 100% and staff were aware of what constitutes as a protected characteristic (In UK law, protected characteristics are specific personal attributes or situations that are legally protected from discrimination. The Equality Act 2010 outlines nine such characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation).

We spoke to 11 members of staff who worked on Coniston ward. Staff were able to describe types of incidents that would require a safeguarding referral, who they would report to, and knew who their Freedom To Speak Up Guardian was (Freedom to Speak Up Guardians provide an additional route for workers to speak up. They complement, and do not replace existing channels such as line management, human resources, patient safety teams or incident reporting systems. Guardians make sure that people who speak up to them are empowered, treated equitably, and thanked).

There was a blanket restrictions register in place for the ward which was regularly reviewed. This included items which were risk assessed as being unsafe for the environment/patient group.

We reviewed 12 months of data relating to restrictive practice and use of force. There were 0 incidents of rapid tranquilisation in this time. The site does not have a seclusion room. There was minimal use of restraint and in context of redirecting patients where de-escalation was not possible verbally. The ward linked with the providers Use of Force team provided monthly reports to ensure oversight of incidents and to identify any outliers. The team discussed any restraints at weekly multi-disciplinary team reviews (MDT), and the service has started a new forum to discuss restraint reduction in line with the Safe Wards initiative (a model and intervention program designed to reduce conflict and the use of restrictive practices, like restraint and seclusion, on mental health wards). The hospital director told us that there were strong links and good communication with the local authority in terms of reporting.

We spoke with 5 relatives and 11 members of staff. Staff involved patients, where possible and their carers in creating care plans and risk assessments. The service worked closely with partner organisations to manage risk through multidisciplinary meetings, which were attended by staff, external teams and the patients' carers. Patients were encouraged to attend these meetings. Staff used the least restrictive option when patients and documented changing risk in care plans.

Staff developed positive behaviour support (PBS) plans with patients using a range of information available, such as personal history, family corroboration and observation and assessment whilst on the ward. 5 care records reviewed for Coniston Ward showed detailed and updated PBS plans were in place. These were reviewed on a monthly basis, unless required changes were needed sooner.

We spoke with 4 carers via telephone and one carer in person. Carers told us that there is good communication between staff and carers, that carers are kept informed of patients' care including any changes and that they felt involved. Carers told us they were also informed of incidents efficiently and that the service was responsive to risk.

The 5 care records reviewed for Coniston ward evidenced comprehensive risk assessments, including best interest decisions where people lacked capacity. These were reviewed monthly or updated accordingly in line with the services Risk Management Policy.

The ward environment was safe, clean and well maintained. The hospital director and domestic lead carried out daily walk arounds to ensure standards remained high.

Coniston ward was spacious with an adjoining bedroom corridor from the main lounge. The ward contained its own clinic room, nursing office and communal lounge, there was an adjoining smaller lounge that led into the garden area which also had a basketball activity area. There were mirrors in place in corridors to enable views around corners. There was no CCTV within ward or clinical area's- CCTV only covered the outside of the buildings for security. The environment was clean, furniture was in good condition although staff told us furniture was in the process of being updated at the request of patients.

The décor was collaborative with patient input. There were murals throughout the ward completed with patients, giving it colour and a good source of engagement for patients. The ward had numerous spaces for lower stimulation. There were also rummage boxes within quieter area's to provide stimulation if needed. There were activities that matched abilities of those on the ward and evidence of trips into the community. The garden space incorporated various patient made sculptures and was very welcoming. The garden area was private, spacious and very well maintained. There was a specific area allocated for smoking which ensured those who do not smoke or vape could use the garden without being close to this space.

Bedrooms were personalised and included pictures of the patients key nurse and care team. There were also 'Good Day Plans' which provided staff with information of what a good day looks like to each person. There were also personalised 'Hug in a Box''s- which included things that brought the individual comfort during difficult times. All fixtures were anti-ligature and window were privacy reflected. However, there was no shower or bath within the en-suite bedrooms. There was a shared bathroom within the ward.

All staff carried personal alarms and a response system is in place for staff to respond to emergencies. There were alarms throughout the ward including bathrooms for assistance/to raise alarms.

Boards included information about Independent Mental Health Advocates, information about Deprivation of Liberty (DoLs) safeguards and easy read information. There was information on how to make a complaint or raise concerns.

The ward had fire extinguishers available which were checked and in date- these are regularly reviewed by maintenance. There was a clear fire exit plan. There were ligature cutters and emergency equipment within the nursing office- steps had been taken to ensure staff knew which bags contained emergency life support equipment.

We reviewed the clinic room on Coniston Ward. There was easy access to emergency equipment for staff. The controlled drug balance was correct on review and all temperature and fridge checks were 100% completed. There were no concerns from the inspection team.

There had been 0 serious incidents at the service in the 12 months prior to the inspection.

The service ensured there were enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people's individual needs.

The hospital used a system called Optimus which allowed staff to access this and review the skill mix for each shift, how many qualified staff would be on shift and where any deficits might have been. The system ensured safe staffing in terms of qualified to support worker ratio. On a day shift the qualified staffing equated to 2 nurses on Coniston Ward and one qualified nurse at night. Support worker ratio was entirely dependent on patient needs and observation levels. This was increased where needed and evidenced through observation on the ward.

At the time of inspection, staff mandatory training was at an overall percentage of 96.94%. Training included MHA, MCA and DoL's, Oliver McGowen Autism awareness training, dementia awareness and safety interventions including immediate life support, which was taking place at the time of our inspection.,

The number of qualified shifts covered by agency in the last 12 months was 26. In terms of support staff, this was 408 (this equates to 0.5% of the required support staff hours). There were no shifts left uncovered in the 12 month period reviewed. Agency usage was primarily due to short notice staff sickness, patient unplanned admissions into hospitals and requiring escorting visits. The average sickness rate as a percentage over the last 12 months was 3.2%. The number of instances of Section 17 leave that had been cancelled over the last six weeks due to short staffing on the wards was 0.

Staff we spoke to told us that there were times when staffing is challenging and some patients required enhanced observations. Staff noted that mornings and tea times are busy periods for staff, when providing increased support. Staff told us that if they require more staff, colleagues will often pick up extra shifts. If regular staff are not available managers source agency staff. Staff felt they usually could identify this need early into shifts.

There were comprehensive induction policies and checklists in place for unfamiliar staff. We found there were high level employment checks and DBS screening in place.

The ward was well maintained, tidy and cleaned with a housekeeping team visible throughout the inspection. Cleaning records were up to date when checked. The hospital director completed monthly audits. There were allocated health and safety champions for both Coniston and Kendal wards. The service maintenance team also completed daily walk arounds and would raise any concerns relating to the infection control audit. Infection prevention and control was part of staff’s mandatory training. At the time of our inspection, this was at 96.61%.

Staff told us that they had both face-to-face training and online e-learning in infection prevention and control. Staff also noted they had been shown how to dispose of personal protective equipment appropriately and received training in keeping equipment safe and hand hygiene,. Staff noted that there is a dedicated cupboard for Control of Substances Hazardous to Health (COSHH).

We inspected the clinic room and found it to be well maintained and clean, with all equipment cleaned. Staff completed fridge and room temperature checks in line with policy.

The ward stored medicines records safely, and completed regular audits of medicines stock to identify any shortages. There were processes in place which staff followed to check medicines orders on arrival. Staff completed monthly invoice summaries highlighting any medicines outliers. The ward worked alongside the local pharmacy to ensure patients medication was prescribed and ordered effectively.

As part of our inspection, a specialist advisor (a registered mental health nurse) completed a review of medication charts. We did not find any concerns in relation to the safe handling and storage of medications.