Thornford Park

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 means we looked for evidence that patients were protected from abuse and avoidable harm.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

Good: This meant patients were safe and protected from avoidable harm

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

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

All staff reported and recorded all incidents they should report appropriately. Leaders used learning from incidents to develop and share improvements. For example, a Quality Improvement (QI) project was in place looking at regular reviews to reduce the time patients spend in seclusion. This QI project was initiated on Crookham ward and shared across the hospital. It involved reviewing seclusion on an hourly basis and if no incidents were reported reducing the time patients spent in seclusion.

Staff understood the duty of candour. They were open and transparent and gave patients and their families a full explanation if and when things went wrong.

There was evidence that staff made changes as a result of feedback. For example we saw patients comments about the use of the garden listened to and acted upon by staff.

Staff were debriefed and received support after serious incident including when physical interventions or seclusion had been used.

We work with patients and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when patients move between different services.

The service's referral and admission processes ensured that all essential information about the patient was received to determine if the patients' needs could safely be met. Members of the multi disciplinary team (MDT) liaised closely with other referring services and families prior to admission to ensure good communication.

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. For example, staff from Community Mental Health Teams (CMHT) attended the MDT meeting when patients were due to be discharged from the ward.

We work with patients to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving patients’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did when appropriate. We saw completed safeguarding referrals and evidence of follow up contact with the local authority for outcomes.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Patients told us they felt safe within the wards.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

Staff followed safe procedures for children visiting the service. There was a dedicated visiting area off the ward.

All staff were trained in managing violence and aggression which included using physical interventions. Staff were aware of blanket restrictions and there was evidence of staff reviewing and reducing restrictive practice and blanket restrictions. Staff said their training gave them confidence and that their colleagues had similar skills which enabled them to work effectively as a team.

We work with patients to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

We looked at 8 care records across both wards. Patients said they felt involved in their care. For example, patients attended the MDT meetings and were able to invite others to participate. Some patients did not want to have a copy of their care plan but knew that one was available.

We reviewed 4 incidents where physical interventions were used, reviewing CCTV, incident reports and seclusion records. We saw that the reports corroborated what we saw on the CCTV footage that physical interventionswere used appropriately.

Staff communicated with patients so that they understood their care and treatment. Staff followed communication plans that were in place for patients with communication difficulties.

Patients took part in regular weekly community meetings. We saw the minutes of these and some of the issues discussed including buying takeaway food and the smoking ban.

Staff ensured that patients could access advocacy and posters were displayed on the ward.

We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

Staff did regular risk assessments of the care environment and the ward layout allowed staff to observe all parts of ward. Environment and ligature risk assessments were completed and audited regularly.

There were a few ligature anchor points identified and there was appropriate mitigation in place to safely manage these. Mitigation included high staff to patients numbers and staff always present and visible on the wards. Staff knew where ligature hot spots were and ligature cutters were easily available and staff knew where to access them.

The ward complied with guidance on eliminating mixed-sex accommodation.

Staff had easy access to alarms and patients had easy access to nurse call systems. For example, a staff member was allocated as the security person for each shift and they were responsible for staff alarms and overall ward security.

Seclusion rooms allowed clear observation and two-way communication and had toilet facilities and a clock. The seclusion room on Crookham ward was located just outside the main ward area. Staff assured us risks were managed in moving patients to this area and there were no incidents reported in this area.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency medicines that staff checked regularly. We reviewed the emergency medicines and equipment checks and they were all completed.

We make sure there are enough qualified, skilled and experienced patients, who receive effective support, supervision and development and work together effectively to provide safe care that meets patients’s individual needs.

The service had enough skilled and experienced staff to meet the needs of the patients using the service. However, some staff said having an additional ‘floating’ Healthcare Assistant (HCA) every shift would be of benefit to the wards.

The leadership team worked out a matrix of number of staff needed per shift and had flexibility within that to request additional staff if risk increased or there was extra leave.

At the time of our visit both wards were fully staffed and there were enough staff to meet the needs of patients.

The wards worked to a model of safe staffing where all unfilled shifts were reported and reviewed for safety, planning and support.

When necessary, managers deployed agency and bank nursing staff to maintain safe staffing levels. When agency and bank nursing staff were used, those staff received an induction and were familiar with the ward.

Staffing levels allowed patients to have regular one-to-one time with their named nurse. Staff shortages rarely resulted in staff cancelling escorted leave or ward activities.

There were enough staff to carry out physical interventions. For example, observations, restraint and seclusion safely and staff had been trained to do so.

There was medical cover day and night and a doctor could attend the ward quickly in an emergency.

Staff had received and were up to date with appropriate mandatory training which included Basic Life Support 95% and management of violence and aggression 91%. Staff had also completed the Oliver Mc Gowan autism training with 99% completion. The training was appropriate for the patient group using the service.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. There were clean stickers on equipment that showed when staff had last cleaned it. However, on Curridge ward some communal areas needed re-decorating and the furniture was damaged and in need of replacement. The ward manager assured us there was an ongoing maintenance programme of repairs and refurbishment. Staff explained the high levels of acuity on the wards had contributed to some damage to furniture.

Cleaning records were up to date and demonstrated that staff cleaned the ward areas regularly. We saw cleaning staff completing tasks across the wards.

Staff adhered to infection control principles, including handwashing. For example, we observed staff being bare below the elbow in clinical area.

We make sure that medicines and treatments are safe and meet patients needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

Staff followed good practice in medicines management including transport, storage, dispensing and administration. Medicines reconciliation took place when patients where. Recording, disposal and, use of covert medication was in line with national guidance.

Staff reviewed the effects of medication on patients physical health regularly and in line with NICE guidance, especially when the person was prescribed a high dose of antipsychotic medication. For example, we saw evidence of high dose antipsychotics monitoring with appropriate physical health checks in place. There was evidence of Mental Health Act T2 and T3 forms, completed correctly for administration of medicines.