Windermere House Independent Hospital

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• 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.

Staff assessed patients' needs in a holistic and person-centered way and there was a multidisciplinary approach to delivering care and treatment. We looked at 5 patients' care records. They included admission documents, care plans, risk assessments, PBS and the monitoring tools used to assess the effectiveness of treatment.

All care records were reviewed and up to date. Care plans were reviewed monthly unless reviews indicated sooner. Care records were comprehensive and accessible. They included admission observations, evidenced regular physical health reviews were taking place and evidence of contact with external partners such as GP's, dentists, physiotherapists, advocates and social workers.

Care records were patient-centered, 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 multidisciplinary team meetings.

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

Staff met people's needs in line with current guidance and best practice. We reviewed care plans which referenced the Mental Health Act and Mental Capacity Act where applicable. Kendal 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).

Staff ensured patients had access to therapeutic activities. These included cookery sessions, art therapy, yoga sessions and singing. Patients could also attend a `pop up pub' which served non-alcoholic beverages, which staff facilitated to encourage engagement and activity. There were weekly community meetings and staff used these to discuss activities and local community groups open to patients. 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 the ward and offered activities, training and work related qualifications intended to help patients acquire living skills. Staff ensured that patients had good access to physical healthcare. We saw evidence in care records that staff carried out regular physical health checks, and supported patients to access dentists and routine physical health checks with a GP. Regular 1-to-1 reviews were used to review patient's progress.

Managers ensured staff received supervision and had their work appraised. At the time of our inspection, 95% of staff had complied with their supervision and 92% had been appraised in the last 3 months.

Managers ensured staff had access to specialist training specific to patient needs- this included tissue viability training, positive behaviour support training, ligature risk assessment training, PAT down and search training and trauma awareness.

Teams worked well to support patients on and included families as partners in their care.

Staff shared information about patients at effective handover meetings within the team. We observed a morning meeting, which included the handover of documentation and, minutes of staff and multidisciplinary team minutes.

Managers ensured staff attended regular team meetings. Maintenance staff attended morning meetings and gave updates of ongoing work/new requests from staff for improvements. There were regular multidisciplinary team meetings on the ward.

The teams had effective working relationships, including good handovers, with other relevant teams within and outside of the organisation.

Care records evidenced regular contact with physical health services, social workers and other healthcare professionals involved in the patient’s care.

Ward activities helped promote a healthy lifestyle for patients on the ward . Staff encouraged patients to attend various ward-based groups such as a staying strong group (devised to helping promote healthy coping mechanisms) and, encouraging patients with gardening.

Staff supported patients to participate in the ‘Hull to Lapland Challenge’ to encourage movement and physical activity for walking. Staff ensured that activities were accessible for the patients on the ward and tailored community visits to suit patients’ needs. In the month prior to our inspection, patients were supported to have trips to Spurn Point, Hessle Foreshore, and local garden centres.

Staff ensured that food choices were wide ranging and that healthy options were always available. Staff also supported patients to access physical health appointments; kept records of contact with GP’s and incorporated physical health needs into care plans.

Staff 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 provider's restrictive practice group. Blanket restrictions were regularly reviewed to ensure least restrictive practice was being used and restrictions were discussed with senior leaders during regional audits.

Staff encouraged the completion of patient surveys. We reviewed surveys which had been completed and found the responses were all positive. Staff also attended monthly `lessons learned' meetings in order to look at what actions could be taken to improve outcomes.

Staff used recognised national rating skills such as the 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 in order to review any incidents and prevent future recurrences.

Staff recognised patients achievements during their admissions.

Staff utilised technology to help support patients and carers to stay connected where needed. Carers who lived too far to travel told us they were able to communicate and join meetings through video link. Staff used technology to support a patient who's fist language was not English, to source music, videos and engage him with family.

We inspected five care records on Kendal ward which all contained consent to treatment forms, or in place of these best interest decisions- which were specific to individual decisions. Staff took steps to ensure patients were supported to make their own decisions and this was evidenced by regular 1-1 meetings, multi-disciplinary meetings and ensuring people understood their care and treatment through rights being regularly read. Patients who lacked capacity to make specific decisions had assessments in place for this and these were recorded appropriately. Staff understood the importance of personal history, family corroboration and cultural needs. All patients had consent to treatment forms completed.

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.