Windermere House Independent Hospital

On this page

• 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.

As part of our inspection, we used the Short Observational Framework for Inspection (SOFI). SOFI is a tool used by our inspectors to capture the experiences of people who use services who may not be able to express this for themselves. The observations do not replace talking to people who use services but can help an inspector get a clearer picture. This helped us to identify that there was a strong culture of care and compassion towards patients.

Interactions between staff and patients were very positive. Inspectors observed staff interact and engage with patients in a warm manner during this observation. We observed staff of all roles demonstrate kindness, empathy and compassion towards patients.

Staff demonstrated high level knowledge of de-escalation techniques and used these accordingly when patients were confused or distressed.

Staff knew patients' needs well and were able to tailor responses to distress to meet their needs quickly, effectively and discreetly to avoid further escalation. We reviewed positive behaviour support plans in place for patients and saw evidence that staff were well versed varying out the steps outlined in these plans in order to reduce the patient's anxiety and heightened behaviour.

Staff assessed patients to determine which ward would suit their personal needs better. Staff were able to transfer patients to Kendal ward from Coniston ward if their needs could be better met on the ward due to physical frailty following risk assessments and discussion with both patient and carers and the multi-disciplinary team. Patient surveys evidenced that patients felt staff were kind and caring. Staff we spoke to were passionate about the care they delivered to patients, and this was evident in their observed approaches and practice.

Staff made reasonable adjustments to suit the needs of the patients. This included the provision of specialist equipment such as adapted chairs and seating. There were boards within patients' bedrooms which outlined how to improve that person's day and what they enjoyed doing on the ward. This enabled staff to ensure they provided meaningful, person- centred activities for patients.

Patients had a choice of food to meet the dietary requirements of people's cultural needs and to account for allergies and intolerance's. We saw evidence in care records that staff assessed patients' nutritional and hydration needs and, created care plans around dietary requirements for patients where needed.

Patients' physical health was monitored routinely and care plans were amended if people required more intensive observation.

Staff ensured that patients had access to appropriate spiritual support. Patients had access to a local church and the vicar completed visits to the ward to offer spiritual support to patients. Staff were able to reach out to various links to accommodate people's religious needs.

Staff ensured that patients could obtain information on treatments, local services, patients' rights, how to complain. The information provided was in a form accessible to the particular patient group including easy read where necessary. Staff made information leaflets available in languages spoken by patients. All staff understood how to seek access to interpreters where needed.

Staff created positive behaviour support plans for patients which outlined ways to maximise their independence, choice, and control and how staff could support them to do so.

Staff encouraged patients to attend their multidisciplinary team meetings to provide feedback and share their views on their care. Carers we spoke with felt included and listened to during these meetings.

There were information boards on the ward which identified activities available, groups that had planned activities in 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 with 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.

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 and, plays a vital role in identifying and managing pressure ulcer risk), Galatean Risk and Safety Technology 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 evidenced regular use of these tools to monitor patient need.

Staff were able to recognise and respond to changes in patients' behaviour and 95% of staff across the hospital had completed their training in the management of violence and aggression. The level of knowledge staff held in de-escalation and recognising patient needs was reflected in the fact that rapid tranquilisation had not been used and there was a low use of restraint. Staff had not used 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 supported them in a caring and dignified way, escalating the situation appropriately.

Staff understood the needs of their patients and responded to any changes in needs appropriately. We observed staff respond to a physical health medical emergency, with care and compassion. Staff were able to very quickly identify the signs and symptoms of a stroke, appropriately seek the correct emergency equipment and contact emergency services. Staff ensured the person's privacy and dignity were maintained and offered the person reassurance throughout.

Staff assessed any signs of agitation; patients' 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 verbal de-escalation, evidencing they knew the patient's needs well.

We spoke to 11 members of staff who work on Kendal ward. The majority of staff we spoke to had worked within the service and Kendal ward for many years, which evidenced good staff retention.[RB1] 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 told us that they would utilise this route if they felt it necessary.

Staff told us that leaders were very supportive and went beyond what most people would do. The staff we spoke with told us that morale was good, although some days were more pressured than others. Staff felt respected, supported and valued. They felt positive and proud about working for the provider and their team.

Staff had access to support for their own physical and emotional health needs through an occupational health service and managers regularly checked in to ensure wellbeing needs were met.

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 absence was an average of 2.7% and long-term sickness absence was an average of 2.3%.