Thornford Park

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• 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 patients 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 changed to requires improvement because patients reported that staff did not always treat them kindly or behave appropriately towards them. Patients complained that the ward was very noisy and that it was difficult for them to relax.This was a breach of regulation 10: Dignity and respect.

The provider did not ensure that the food was of good quality, tasteful and of good portion sizes. We asked patients across the forensic wards to give feedback on the food. This was a breach of regulation 14: Meeting nutritional and hydration needs.

However,

Staff directed patients who used the service to other services when appropriate and, if required, supported them to access those services.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

We have not awarded this service a score for Caring.

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

We always treat patients with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect.

We received mixed feedback from patients about how staff cared for them. Whilst 13 out of the 23 patients we spoke with across forensic wards said that staff treated them with kindness and compassion, 10 patients across 5 wards including Adbury, Donnington, Bucklebury, Kingsclere and Headley said that staff did not always treat them kindly or behave appropriately towards them. We raised these concerns with the provider following the assessment and provider told us that they had recognised this prior to our assessment and started an action around creating a dignity charter. However, at the time of this assessment, the actions were not yet embedded.

We asked one person if they felt the wards were safe and were able to raise concerns with staff if they felt unsafe. The person told us they were more worried about staff, because they reported they had been bullied. Four patients told us that staff always stayed in the office and did not always engage with them. In addition, four patients on Donnington, Adbury and Headley wards reported that it was very difficult to get a drink. However, the provider informed us following the assessment that each of these wards has a patient drinks station with hot and cold water dispensers, fridge for milk and containers for tea and coffee, which are freely available 24/7 for patients to use and do not need staff to enable access to these drinks stations.

While some patients said staff provided them with help, emotional support and advice when they needed it, two patients reported that when staff did night time observations, the rays from the torches usually woke them up. In addition, some patients reported that they did not always have one to one time with their named nurse. The provider informed us following the inspection, that the torches were specially adapted coloured lights and this was the least intrusive approach to ensure signs of life during night time observations.

Staff directed patients who used the service to other services when appropriate and, if required, supported them to access those services.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. For example, we saw that staff had arranged for a Muslim person to be visited by an Imam on the ward and another person who was a Christian was being seen by their vicar. One person reported that staff had supported them to attend Church on Sunday.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

Staff maintained the confidentiality of information about patients. However, some patients reported that they felt staff were talking about them as they often spoke their local dialect in front of patients, which made them uncomfortable.

We treat patients as individuals and make sure their care, support and treatment meets their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We asked patients across the forensic wards to give feedback on the food. Of the 16 patients we spoke with about food, 75% gave very negative feedback on the food. Some patients said that the food was not always fresh. Patients said that there were not always vegetarian options. Patients reported that the food was not always tasteful, and the portion sizes were small and not filling. Patients said they often get takeaways to meet their dietary needs. We saw that the provider was already taking action to improve on the food to ensure people’s nutritional and dietary needs were being met including reviewing the menu and collecting people’s feedback. We observed lunchtime on Highclere ward during our inspection. One person had requested vegetarian food, but staff reported there was no vegetarian food left. However, there was a pickled sandwich, but the person did not eat pickles. The person left without eating lunch.

We reviewed the provider’s service user experience survey from 2024, and we saw that patients had raised concerns about the food previously. While the provider had taken some action to address these concerns such as 3 monthly reviews for the hospital menu and a rating system for the meals, this was not effective.

There was ample information across all wards including information on how to make a complaint, information about advocacy services and information on how to request a tribunal and legal support, however, the information was not always in accessible format for the client group. For example, Tadley ward, a medium secure setting for men with a diagnosis of a learning disability who may also present with complex mental health needs, did not have information in in Easy Read format in line with NHS England’s recommendations.

The service made adjustments for disabled patients. For example, patients with mobility issues or risk of falls were placed on enhanced monitoring or supported on a one to one basis by staff. Some wards were accessible for wheelchair users.

Managers and staff told us they had easy access to interpreters and/or signers, and this was provided by a third party agency. Staff told us that there were information leaflets available in languages spoken by patients such as Arabic.

We promote patients’ independence, so they know their rights and have choice and control over their own care, treatment and wellbeing.

Patients felt staff cared for and supported them to live as they wanted to, and staff supported them to have choice and control over their own care and treatment.

Patients could keep in touch and meet up with those who were important to them, including family, friends and patients who shared their interests, identity and culture. For example, patients reported that the provider organised events on Tuesdays and Saturdays where patients could meet with and interact with their peers from other wards.

We listen to and understand patients’ needs, views and wishes. We respond to these in that moment and will act to minimise any discomfort, concern or distress.

Patients reported that the wards were very loud and uncomfortable because of the emergency alarms going off on other wards. While some wards had quiet rooms, during our assessment we observed, for example, Bucklebury ward was very noisy with alarms sounding for long periods of time and lights flashing on the ward outside of bedrooms even when the alarm was activated on another ward in the hospital.

The bedrooms were not located in a specific corridor away from communal day areas, instead they were on the main ward thoroughfare so there was limited opportunity to find a quiet space, with a pool table outside patients’ bedroom.

Patients told us they mostly stay in their bedroom to have a quiet time. However, the sound of the alarms often woke them up.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. Most staff told us they rarely used restraint. We undertook a random review of CCTV of some incidents, and we saw that staff were professional and promoted patients’ wellbeing during restraint.

We care about and promote the wellbeing of our staff, and we support and enable them to always deliver person centred care.

Staff felt respected, supported and valued. Staff 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.

The provider reported a 4% reduction in staff turnover between in the last 24 months. While the sickness rate for admin staff had reduced by 3% during this time period, the sickness rates for the medics had increased by 3%.

The provider recognised staff success within the service. For example, through staff awards. However, some staff reported that they did not know what they need to do to get an award.

Staff appraisals included conversations about career development and how the provider could support them.