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.

The service made sure people were at the centre of their care and treatment choices and decided, in partnership with them, how to respond to any relevant changes in their needs. Care plans were written collaboratively with patients and included carers in the process where possible.

Staff had enabled patients to be involved in the decoration of the ward and encouraged them to personalise both the communal areas and their individual bedroom space. Staff had involved patients in creating murals within the corridor spaces and communal lounges.

Care we witness was person centred and compassionate. Staff demonstrated that they understood patients individual needs and responded to these in line with care plans and positive behaviour support plans.

Staff had 1-to-1 engagement with patients, and this was reflected within their care records. Positive behaviour support plans were detailed and included the patient’s personal history, preferences and dislikes.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff enabled patients to access courses to help promote their independence and living skills through various activities. When patients had completed courses, staff celebrated this and gave recognition to patients. 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.

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 his and his wife’s anniversary. Care provision was goal specific, meaningful to patients and integrated family and carers into the process.

Patients and families were integrated into the service and carers told us they felt involved throughout their relatives admission. Information leaflets were available for patients and carers and new admissions were given tours of the ward to understand the environment. The ward ensured links with community professionals were continued into discharge such as district nursing. MDT meetings ensured contingency plans were in place for discharges.

During our inspection we noted that Care Quality Commission posters with ratings were displayed throughout the hospital for patients and visitors to see. Staff made notifications to external bodies as needed. Information governance systems included confidentiality of patient records. 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. Staff audited records to ensure there were no gaps in record keeping, Mental Health Act documentation or Deprivation of Liberty Safeguards paperwork.

We observed information posters relating to hospital admission in the visiting area 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.

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 a life enrichment bulletin for June (published the day before our site visit) had been shared with staff and the people who used the service. This included updates from other sites in the Barchester group.

Managers circulated monthly bulletins to the team and we observed posters with news and updates within both staff and patient area's. Staff told us handovers were good and that information sharing from management was strong.

Staff told us that they did feel listened to and respected by managers. Some staff felt that they could raise issues but did not always feel they would be addressed. We reviewed governance meeting minutes which showed that issues raised were addressed or had action plans to address concerns. Staff told us they were invited to meetings, including multidisciplinary team meetings where possible and had involvement in developing the ward.

There were ‘feedback and suggestion’ posters indicating how people could provide staff with feedback about the service they received. We reviewed data from the last year and of 46 responses received; 11 were complaints, 34 were positive feedback and one 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 Wi-Fi 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, so staff had ordered replacements.

Carer feedback was positive in terms of people knowing how to raise complaints and some carers stated they have never needed to complain. 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 process for referring patients to the service. 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 was situated on ground level enabling access for wheelchair users and the garden areas were accessible. There was appropriate staffing within the multidisciplinary team and at the time of our inspection, a whole-time psychologist and occupational therapist were due to start working within the service. There was a consultant psychiatrist in place who provided weekend cover.

Appropriate referrals were made and social care colleagues 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. Information was available in different formats for patients admitted to the service.

During our inspection, we did not identify any barriers to care, support and treatment. Staff had regard to the needs of people with different protected characteristics, including for people with long term conditions such as dementia and 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 guardian.

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 LGBT+ 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. Both the patient’s and carer’s voice was noted in documentation. Where appropriate, patients had their wishes documented[GB1], including DNAR’s (do not attempt resuscitation) paperwork.

During our inspection we observed good end of life planning which was highly compassionate.